Prenatal Education Classes REGISTRATION FORM - Mount Sinai & MC Prenatal Classes MOUNT SINAI MEDICAL CENTER, MIAMI BEACH FL: Time will be allotted to answer questions related to the hospital. 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). I AM NOT GIVING BIRTH AT MOUNT SINAI. CAN I TAKE YOUR CLASSES? YES! Our classes are open to those who will be birthing at any hospital facility in Florida or throughout the U.S. and for those who plan to birth at home or in a birth center! The information presented during our classes are applicable to you no matter where you are giving birthEstimated 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 VIRTUAL CLASSES: Online - Google Meet IN-PERSON CLASS LOCATION - CLICK HERE for Class Location & Map CLICK HERE for Parking Fees at Mount Sinai (Class Fee does NOT include Parking Fee) PAYMENT OPTION 1 - Pay with a Debit or Credit Card (Visa, MasterCard or American Express Accepted)GROUP CLASSES - SELECT CLASS TYPE GROUP CLASS - (VIRTUAL) - No Additional Fee GROUP CLASS - (IN-PERSON) - No Additional Fee PRIVATE CLASSES - SELECT CLASS TYPE PRIVATE CLASS - (VIRTUAL) - $125.00 Additional Fee for 1 Class PRIVATE CLASS - (IN-PERSON) - $175.00 Additional Fee for 1 Class ALL PRIVATE CLASSES: You must receive written approval to confirm a private Class. TO RECEIVED APPROVAL OR TO PURCHASE MORE THAN 1 PRIVATE CLASS: Contact MC for more Information: 954-433-2273 or momsdoula@mcdsonlinedoulas.com PRIVATE CLASSES: Address Where the Private Class will take place PLEASE ADD THE FULL ADDRESS (Include Apt # or Suite # and Zip Code)GROUP CLASSES - SELECT CLASS TOPIC & PRICE 5-Hour Prenatal Childbirth Preparation Class 3-Class Series: Prenatal Childbirth Preparation Class 5-Class Series: “Fear•Less”® Childbirth 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 CLASSES - SELECT CLASS TOPIC & PRICE 5-Hour Prenatal Childbirth Preparation Class 3-Class Series: Prenatal Childbirth Preparation Class 5-Class Series: “Fear•Less”® Childbirth 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 TO PURCHASE MORE THAN 1 PRIVATE CLASS - Contact MC for more Information: momsdoula@mcdsonlinedoulas.com 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