Private Classes-contact me to secure date(s), once confirmed, then make payment

First Name *

Last Name *

Partner's Name *

"ESTIMATED" Due Date *

Email Address *

Street Address *

City *

Telephone Number *

Class Type *
1 Private Class, 3.5 Hours ($295)2 Private Classes, 3 Hours each ($425)1 Private Class, 7 Hours ($425)Private Confident Breastfeeding Class, 2.5 Hours ($175)

Where do you plan to birth? *
HomeHospitalBirth Center

Who is your Care Provider? (Midwife or OB) *

How did you hear about this class? *
FriendThis websiteFacebookCare ProviderOther

Please be more specific, so we may send Thanks.

I have read and agree to the "Terms and Conditions" outlined on the Kopa Birth website: *
I agree

Message-Proposal on Potential Days/Times for the Private Class: