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Registration Form


You do not need to register for Great Expectations, Little Fingers/ Little Toes or Breastfeeding classes. Please check the class schedule carefully for location and time as it varies. We urge you to take the class 9 Months and Counting as soon as you find that you are expecting, followed by Great Expectations. These classes will give you important information about your pregnancy as well as your delivery at Baptist Health Lexington.

You do not need to register for Great Expectations, Little Fingers/Little Toes or Breastfeeding.

Map

We recommend you print a copy of your selections from this page for your files, or use the printer-friendly version to print a handwritten form for faxing.

Registrant Information
* Required Fields
* 1st Registrant Name
2nd Registrant Name
Parent's Name Parent's Name and Registrant Age are needed for the New Brother/ New Sister (Sections 1 & 2) and Safe Sitter classes only.
Registrant Age
* Address
* City:   * State:   * Zip:
* Primary Phone
* Email
* Physician's Name
* Due Date
Baptist Health Lexington Employee Yes   No
Class Information
Please indicate the class(es) and date(s) you would like to attend:
Class Date (mm/dd/yyyy) # Attending
Comfort Measures for Childbirth
Laboring the Natural Way
Marvelous Multiples
New Brother/New Sister Section 1 (Ages 3-7)
New Brother/New Sister Section 2 (Ages 8-11)
Pediatric CPR
(PCPR and First Aid : $30 per person; $50 per couple; $15 each additional caregiver)
Safe Sitter
($85 per child)
(Payment must accompany registration)
Sibling Information
Please list the name(s) of the sibling(s) planning to attend.
For New Brother/New Sister (Sections 1 & 2) classes only.
Sibling Full Name Age
Sibling Full Name Age
Sibling Full Name Age
Sibling Full Name Age
Credit Card Information
NOTE: Credit card information is only necessary for those classes that require payment.
Only the Pediatric CPR and Safe Sitter classes require payment at time of registration.
Type:
Name on card:
Account Number (without spaces):
Expiration Date:  
Amount to be Charged: $
Additional Information
How did you learn about our Childbirth classes?
Physician Radio
Friend/Relative TV
Newspaper Website
Other  
Comments
Do you have any additional comments?

     

A 24 hour notification of cancellation is required for a refund of your registration fee.


To pay by check, complete this form and print it.
Mail it with your check made payable to Baptist Health Lexington to:

HealthwoRx
1740 Nicholasville Rd.
Lexington, KY 40503

For questions or scholarship information please call:
(859) 260-6357
Fax (859) 260-4153