Birth Center Mail in Form
Print out and mail in today!
Name: ________________________________________________________
Address:_______________________________________________________
City: ______________________
State & Zip:_____________ ___________
Phone (Day):________________
Phone (Evening): ____________________
Sign me up for
:
Baby Beginnings $45 per couple - Dates:
Baby Beginnings - Weekend Course $45 per couple - Dates:
Baby Beginnings - Saturday Only $45 per couple - Dates:
Baby Beginnings - Teen Pregnancy Free - Dates:
Baby Beginnings - Refresher Course $25 - Dates:
NFL - New Father's League *$5 - Dates:
Breastfeeding Course $5 - Dates:
Basic Newborn Care & Safety *$5 - Dates:
New Baby Day Camp $5 per child - Dates, Name & Age:
Yes, Please call me with the date for the next Nature's Nourishment II Breast-feeding Support Group Meeting.
Name of Physician:
_________________________________
Baby's Due Date:
_________________________________
Amount enclosed: $
_________________________________
You many register for more than one class.
* Free with Baby Beginning registration.
Refund Policy: Requests should be made before the date of the class:
Call 584-4355.
Make Checks Payable to
: Parkview Medical Center
Mail to
: The Milky Way - Parkview Breastfeeding Center
1316 N. Grand Avenue
Pueblo, CO 81003