October 30th, 2007
December 12, 2007
February 27, 2008
May 7, 2008
June 18, 2008
These classes run from 7 pm - 9:30 pm

Class dates are subject to change.  As well, we cannot guarantee that the class you have selected will be available.  In the event that it is full, we will contact you to discuss other options.

Mother's Name:    Mother's Age: 

Partner's Name/Name of person attending the class with you:   

Address:

City:    Postal Code: 

Phone Number: 

Work Number:  Can you be reached at work?

Email Address:    Please provide an email address where can reach you now as well as after you have the baby, when you may be on maternity leave.

Would you like to be added to Birth Roots Connections, a listserv for our clients to share information and experiences? (You can unsubscribe from this listserv at any time.) Yes No

Due Date:  

Planned Place of Birth:
Home St. Boniface Hospital Women's Hospital

Is your caregiver a:
  Midwife General Practitioner Obstetrician

Midwife or Doctor's name:   

Doula's name, if applicable:

If you have other children, how old are they? 

If applicable, please briefly describe your previous breastfeeding experiences.

If you have taken Birthing Classes, where did you take them?  

Have you ever attended a La Leche League meeting? 
Yes No

Which books you have read about breastfeeding? (Please check all that apply)
Books by La Leche League
Books by Dr Jack Newman
Books by Sheila Kitzinger
Books by William & Martha Sears
What to Expect When You're Expecting
I haven't read any books
Other, please specify:


Please list any specific topics you would like addressed in your class or concerns you have.

How did you hear about us? 

Please press the 'Submit' button to process your registration