MSMC Employee Complimentary Class Registration Form REGISTRATION FORM - MSMC Employee Complimentary Class THIS FORM IS FOR MSMC EMPLOYEES ONLY Were you Approved for a Complimentary Class? If not: REQUEST APPROVAL HERE Approval grants you 1 (one) Prenatal Education Class of your choice. I RECEIVED APPROVAL: Complete Registration Form Below VIRTUAL CLASSES - Within 72 hours a Confirmation Message will be emailed to you and includes details about your class and the Link you will use to access your class. IN-PERSON CLASSES - Within 72 hours a Confirmation Message will be emailed to you and includes a map and directions for the location of your class. If you do not receive your Confirmation email, please contact us at: mtsinaichildbirthclass@mcdsonlinedoulas.com OR call us at 954.433.CARE (2273). IMPORTANT - Your class registration is subject to confirmation that a class has other couples registered to attend. If no one registered to the class you are requesting to attend, you will be informed and offered the option to attend another class date that has confirmed registrants. Complimentary classes cannot be Private Classes attended just by you and your partner. REGISTRATION FORM - MSMC Employee Complimentary Class If you wish to register & pay for more classes, please complete our standard Class Registration Form HERE 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 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 BackupYour 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 NameBirth Location Name: (Hospital's Name, Birth Center Name or Home Birth)(Required) MOUNT SINAI EMPLOYEE INFORMATION I AM AN EMPLOYEE OF MOUNT SINAI MEDICAL CENTER, MIAMI BEACH, FL.(Required) Yes, I am a MSMC Employee UPLOAD MSMC EMPLOYEE BADGE PICTURE(Required)Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB.Please Upload a Picture of your MSMC Employee Badge. This image will be used to identify you as a MSMC Employee and grant you 1 (one) Complimentary Prenatal Education Class of your choice. Title of the document