Event Registration
Use the form below to complete your registration for this event.
*Indicates required fields.
Your Event
Siblings and Parents
Time: 6:00 PM - 7:00 PM
Cost: Free
Event Date
*
Please Select
September 10, 2024
November 12, 2024
Ticket
*
Please Select
General (Free)
Your Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Parent Date of Birth:
*
Free classes are for patients delivering at CoxHealth only. Are you delivering at CoxHealth?
*
Yes
No
Who is your OB provider?
*
Due date:
*
Name of second parent attending:
*
Child 1 - First & last name
*
Child 1 - Age:
*
Child 1 - Gender:
*
Please Select
Male
Female
Child 1 - T-shirt size:
*
Please Select
4T - Toddler
XS Youth (size 5)
S Youth (size 6-8)
M Youth (size 10-12)
Child 2 - First & last name
Child 2 - Age:
Child 2 - Gender:
Please Select
Male
Female
Child 2 - T-shirt size:
Please Select
4T - Toddler
XS Youth (size 5)
S Youth (size 6-8)
M Youth (size 10-12)
Child 3 - First & last name
Child 3 - Age:
Child 3 - Gender:
Please Select
Male
Female
Child 3 - T-shirt size:
Please Select
4T - Toddler
XS Youth (size 5)
S Youth (size 6-8)
M Youth (size 10-12)
Child 4 - First & last name
Child 4 - Age:
Child 4 - Gender:
Please Select
Male
Female
Child 4 - T-shirt size:
Please Select
4T - Toddler
XS Youth (size 5)
S Youth (size 6-8)
M Youth (size 10-12)
In-person attendance allows for the best experience. How would you like to attend this class?
*
Please Select
In-person
Virtual
Submit
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