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* 1. Your first and last name:

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* 2. Will you be 25 weeks at the start date of the class series?

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* 3. When is your due date?

Date

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* 4. Where are you planning to give birth?

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* 5. Are you a Birth Detroit Care Client 

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* 6. What's your phone number?

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* 7. What's your email address?

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* 8. What's the best way to communicate with you? (Choose all that apply)

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* 9. What's your address? (Include city, state, and zip code)

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* 10. What do you and your support person already know about 
pregnancy and childbirth?

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* 11. What type of learner(s) are you?

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* 12. How comfortable are you at this point to meet in person for one of our six classes?

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* 13. What do you want to get most from your childbirth course? (Choose all that apply)

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* 14. Living into our values of safety, love, trust and justice, everyone is welcome to enroll in our courses. We share the actual cost of our course to honor the work of our providers. To make the course accessible to everyone, we simply ask participants to pay what they are able to pay. We understand this may vary from actual cost to no cost. Please select what you can afford to pay for this course; please note our actual cost is $200/virtual couple.

You will pay at the end of this survey.

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