Exit Event Registration Form How U Birth Childbirth Education Class Question Title * 1. Name of birthing person Question Title * 2. Name of partner/support person that will attend class with you (please write n/a if you will be attending alone) Question Title * 3. Email Question Title * 4. Phone number Question Title * 5. Our class consists of 3 sessions. We ask that participants attend all three sessions. Please confirm the dates that you are able to attend the childbirth class (select all that apply). May 7th, 6-830pm May 21st, 6-830pm June 4th, 6-830pm Question Title * 6. As a part of this class, we ask that you watch a video series and complete practice at home in between our classes. Do you have access to technology (such as a computer, tablet, or phone) where you are able to access and watch videos? Yes No Question Title * 7. Do you follow any of the these dietary restrictions? (Please select all that apply.) Vegan Vegetarian Religious Dietary Restrictions (e.g., Kosher, Halal) Lactose Free Weight Loss Diet (e.g. Keto, Low Sugar, Weight Watchers) Low Salt Food Allergy (e.g. gluten free, peanut free) Intermittent Fasting I do not follow any of these dietary restrictions Prefer not to answer Other (please specify) Question Title * 8. How did you learn about our class? Flyer Healthcare provider My doula Friend/Family member Social media (facebook, instagram, etc) Other (please specify) Done