Prenatal Education Classes

REGISTRATION FORM - Mount Sinai Medical Center & MC Prenatal Classes

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❓ WHAT IS THIS REGISTRATION FORM FOR? Complete this form to register and pay for an upcoming Mount Sinai Medical Center Prenatal Class. Upon submitting this form, you will see an auto-generated message confirming it was received. Over the coming days, we will email you a formal confirmation message with more class details.

❓ WHAT ARE THE DATES & TIMES OF UPCOMING CLASSES? TAP HERE to see our Calendar

‼️ FOR IN-PERSON CLASSES: We must have 4 confirmed registrations for In-person classes, otherwise the class will be automatically converted to a virtual class. Contact Us if you have questions.

Estimated Due Date (or) Induction Date (or) Cesarean Date:(Required)

Month

Day

Year

Your Name:(Required)

First Last

Person Attending Class With You:

First Last

Best Contact Phone #(Required)

I consent to receiving text messages so the Class Instructor can communication with me:(Required)

Yes

NO marketing material will be sent to you. Text is used only as a form of communication with the Class Instructor to provide important class related information.

Preferred Email:(Required)

This is the Email Address we will use to send you the formal Class Confirmation & the Link you will use to access your class.

Alternate Email:

Backup Email - Include this Address if you would like us to send your Partner the Class Link or as a Backup

Your Full Address:(Required)

Street Address City ZIP / Postal Code

Your OB and/or Midwife's Name:(Required)

Please include the Providers Full Name & Group/Practice Name

Birth Location Name: (Hospital's Name, Birth Center Name or Home Birth)(Required)

PRENATAL CLASS MENU & PAYMENT AUTHORIZATION

CLASS SELECTION & PAYMENT — Choose your preferred class format: In-person or Virtual.

IN-PERSON CLASSES

IN-PERSON CLASS

IN-PERSON CLASS TOPICS

Fear•Less® Childbirth: A Labor & Birth Masterclass

Fear•Less® Express: Baby & Breastfeeding Basics Mini-Class

IN-PERSON DATE(S) YOU WILL ATTEND:

LIST ALL IN-PERSON CLASS DATES YOU ARE REGISTERING TO ATTEND. TAP HERE FOR CLASS CALENDAR

🚗 MOUNT SINAI PARKING FEE: Class Fee does NOT include Parking Fee. TAP HERE for Parking Fees

‼️ IN-PERSON REGISTRATION MINIMUM: We require 4 confirmed registrations to confirm an In-person Class. If we do not meet our minimum, the class automatically converts into a Virtual Class. Should you register for an In-person Class and the minimum is not met by the registration deadline, you will be contacted and offered the choice to attend virtually or move to another In-person Class. Please review our Refund Policy HERE.

VIRTUAL CLASSES

VIRTUAL CLASS

VIRTUAL CLASS TOPICS

Fear•Less® Childbirth: A Labor & Birth Masterclass

Fear•Less® Breastfeeding: Confidence from the First Latch

Fear•Less® Baby: Confident Beginnings With Your Newborn

Fear•Less® Feeding: Pumping & Formula 101

Fear•Less® Cesarean: Beautiful Belly Birth

VIRTUAL DATE(S) YOU WILL ATTEND:

LIST ALL VIRTUAL CLASS DATES YOU ARE REGISTERING TO ATTEND. TAP HERE FOR CLASS CALENDAR

CREDIT & DEBIT CARD PAYMENT FORM — Visa, MasterCard or American Express Accepted

TOTAL CHARGE - FOR IN-PERSON -OR- VIRTUAL CLASSES

CREDIT & DEBIT CARD PAYMENT FORM:

Cardholder Name

Card Details

PAYING WITH CREDIT/DEBIT CARD: Payment Receipt will be sent to you separately. If you require an Invoice, please contact MC: momsdoula@mcdsonlinedoulas.com

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ALTERNATE PAYMENT OPTION — Pay by Zelle or Venmo

MC accepts payments made by Zelle or Venmo as alternatives to payments made by credit or debit card. If you wish to pay by Zelle or Venmo, please complete this entire Registration Form. However, leave the card payment form above BLANK. Your registration and class confirmation are not complete until full payment has been received and verified by MC.

TAP HERE FOR
ZELLE & VENMO RECIPIENT INFORMATION

Zelle or Venmo Payments are made to:
Dr. Marlo Robinson (MCDS President & Directress)

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REFUND-CANCELLATION POLICY & TRANSFER OF SERVICES:

ALL CLASSES ARE NON-REFUNDABLE — NO EXCEPTIONS
All class payments or fees are non-refundable. However, registration payments are transferable as outlined below.

MISSED CLASS: If you register for an In-Person or Virtual class and do not attend, no refunds will be issued. You may transfer your registration to another class within three (3) months (90 days) from the date of your paid registration. If you do not confirm a new class within this 90-day timeframe, your payment will be forfeited in full. No refunds, extensions, or discounts will be issued.

IN-PERSON CLASS MINIMUM: A minimum of four (4) confirmed registrants is required for all In-Person classes. If the minimum is not met, the class will automatically convert to a Virtual class. You will be contacted and offered the choice to:

Attend the Virtual Class, or
Transfer to the next available In-Person class.

The standard 90-day transfer policy applies. Failure to confirm within that period will result in forfeiture of payment. No refunds or discounts will be issued.

RESCHEDULED CLASSES: If a class (In-Person or Virtual) must be rescheduled due to circumstances beyond our control, you will be notified and offered the option to attend the rescheduled session or transfer to another class date. All transfers must be confirmed within 90 days of your original paid registration. After this period, your payment will be forfeited. No refunds or discounts will be issued.

To request a transfer to another class or to apply your payment towards another Mother’s Care service, please contact us in writing at: momsdoula@mcdsonlinedoulas.com

PAYMENT AUTHORIZATION & ALTERNATE PAYMENT DISCLAIMER

I authorize Mother’s Care Doula Services, Inc. (MC) to charge my card in the amount listed above for one or more prenatal classes based on the selections I have made on this form.

If I choose to pay using an alternate payment method such as Zelle or Venmo, I understand that my registration and class confirmation are not complete until full payment has been received and verified by MC. I am solely responsible for ensuring that payments are sent to the correct recipient and that the payment information matches that of MC’s President and CEO, Dr. Marlo Robinson. I understand that Mother’s Care Doula Services, Inc. is not liable for payments sent in error or to an incorrect recipient. If I send funds to the wrong person or entity, I understand that it is my sole responsibility to recover those funds directly from the party to whom payment was sent. If I have questions about a charge or believe I have been billed incorrectly, I agree to contact Dr. Marlo Robinson, President & CEO, at (305) 979-2823 or momsdoula@mcdsonlinedoulas.com for resolution.

REFUND & CANCELLATION POLICY ACKNOWLEDGMENT:(Required)

I have read and agree to the Refund & Cancellation Policy

PAYMENT AUTHORIZATION & ALTERNATE PAYMENT POLICY ACKNOWLEDGMENT:(Required)

I have read and agree to the Payment Authorization & Alternate Payment Policy

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WHAT HAPPENS AFTER I SUBMIT THIS FORM & PAYMENT?

(1) An automatic Confirmation and "Thank You" message will appear on your screen signaling that your Form was received and will be reviewed by our MC Administrative Staff.

(2) An automatic follow-up email message will be generated and sent to the email address you included on your form.

(3) Our Official Class Confirmation Message will be sent to you. It will include details about your class, dates, time, location, parking instructions (for In-person classes) or the Link you will use to access the online classroom (for Virtual classes) along with a separate Google Invitation.

The Official Confirmation & Google Invite will be sent to you within 72 hours.

(4) I PAID BY CREDIT/DEBIT CARD — Payment Receipt will be sent to you separately from your Credit/Debit Card Company. If you require an Invoice, please contact MC and request one: momsdoula@mcdsonlinedoulas.com

(5) I PAID ZELLE OR VENMO — Make sure you send your payment as soon as possible using the correct Recipient Info. Your class is not confirmed until payment is received. When your payment is made, a Payment Receipt will be sent to you separately from your App.

If you have any questions, please contact momsdoula@mcdsonlinedoulas.com or call us at 954.433.CARE (2273)

© 2025, Mother’s Care Doula Services, Inc. All rights reserved.
This Registration Form and its contents are the exclusive property of Mother’s Care Doula Services, Inc. and are protected by United States copyright law. No part of this Agreement may be copied, reproduced, distributed, or used in any form without the prior written consent of Mother’s Care Doula Services, Inc. Any unauthorized use, duplication, or distribution is strictly prohibited and may result in civil and/or criminal liability to the fullest extent of the law.

I STILL HAVE QUESTIONS! - Please submit your questions here, OR email us at: mtsinaichildbirthclass@mcdsonlinedoulas.com OR contact us at 954.433.CARE (2273).