Prenatal Education Classes REGISTRATION FORM - Mount Sinai Medical Center & MC Prenatal Classes ❓ 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. ❓ ARE ALL CLASSES IN-PERSON? NO. We have 2 classes that are In-person. They are: 1-day, Childbirth Preparation Class (offered on a Saturday or Sunday, 11:00am - 5:00pm) Infant Feeding & Newborn Basics Combo Class (offered on a weeknight, 6:00pm - 8:30pm) In-person Class Location: Mount Sinai Medical Center Unless otherwise specified, all other classes we offer are VIRTUAL. ❓ WHAT ARE THE DATES & TIMES OF UPCOMING CLASSES? To see our class calendar TAP HERE. ❓ WHAT IS THE REFUND / CANCELLATION POLICY? All classes are NON-REFUNDABLE. TAP HERE for details. ‼️ 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. You will be contacted by the registration deadline if the class is converted. You are able to transfer to the next in-person class if you do not wish to attend virtually. 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 & MC CLASS MENU & PAYMENT OPTIONS IN-PERSON CLASS LOCATION - Mount Sinai Medical Center, Miami Beach, FLCLICK HERE for Parking Fees at Mount Sinai (Class Fee does NOT include Parking Fee)VIRTUAL CLASSES: Online - Google Meet GROUP CLASSES: Classes you take with other expectant couples. ONLY AVAILABLE FOR: “1-Day Childbirth Preparation Class” and “Infant Feeding & Newborn Care Basics Combo Class”. No additional fees to attend group classes. Minimum of 4 couples for In-person Classes. If the minimum is not met, class converts to a Virtual Class. Contact MC for information about a group class: momsdoula@mcdsonlinedoulas.com PRIVATE CLASSES: Classes are for you and your partner only (grandparents are welcome). You must receive written approval BEFORE confirming a private class. Additional Fee of $200.00 per Class Offered virtually or in your home - Based on Instructors Availability. Contact MC for information about a private class: momsdoula@mcdsonlinedoulas.com PAYMENT OPTION 1 - Pay with a Debit or Credit Card (Visa, MasterCard or American Express Accepted)(PAYMENT OPTION 1) GROUP CLASS - SELECT CLASS TYPE VIRTUAL CLASS IN-PERSON CLASS (PAYMENT OPTION 1) GROUP CLASS - SELECT CLASS TOPIC & PRICE 1-Day Childbirth Preparation Class 3-Class Series: Prenatal Childbirth Preparation Class 5-Class Series: “Fear•Less”® Childbirth Class 3-Hour Infant Feeding & Newborn Care Basics Combo Class 3-Hour Introduction to Breastfeeding Class 3-Hour “Your Amazing Newborn!” Care Class 3-Hour Infant Feeding Choices: Pumping & Storing Breastmilk & Formula Safety 3-Hour Preparing for Cesarean Birth Private Class Additional Fee (PAYMENT OPTION 1) TOTAL AMOUNT DUE: (PAYMENT OPTION 1) 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 Title of the document