Doula Speed Dating - Parents' Registration
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Which date would you like?
All events listed are on Saturdays at 4pm.
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| Feb 11, 2012 Apr 7, 2012 Jun 2, 2012 Aug 4, 2012 Oct 6 , 2012 Dec 1, 2012
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| First Name
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| Last Name
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| Partner/Support Person
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| If you are registering for yourself only, please enter, "self".
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| Due Date
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| Email 1
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| Email 2
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| Phone 1
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| Please include all numbers you can be contacted at in case of any changes to this event.
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| Phone 2
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| Phone 3
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| Is this your first baby?
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| Yes No
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| If no, then how many other children do you have?
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| Where do you plan to have your baby?
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| Home Hospital Other
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| Who are your primary caregivers?
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| Is there anything else you would like the doulas to know about you before the interview? (eg. having twins, preference for waterbirth, allergies you have, pets, smokers/non-smokers, etc)
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| Where did you learn about Doula Speed Dating?
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| My caregiver told me A poster in my caregiver's office Another poster or flyer Online Word of mouth Newpapaper Radio Other Please select all that apply.
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| If you heard about Doula Speed Dating from a friend, please enter their name here so they can be entered in a draw for a prize.
| February's prize package includes a 30-minute Mama Bliss Massage, a fashion sling from Seven Slings, and a $50 gift coupon for baby clothes and toys at Bean Sprouts!
All parents who attend are entered into a separate draw for a 30-minute Mama Bliss Massage!
You can also get entered into the Grand Prize Draw for every registration that you refer!
Good Luck!
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