The Family Plan

Online Registration Form

IMPORTANT: A customer service representative will contact you to confirm your registration via U.S. mail before you attend the class. Please call (804) 327-8708 prior to the class you wish to attend if you do not receive a confirmation.

Some of our classes are very popular and fill up fast. If the class you are registering for is full, you will be notified of the next available class, and may register for that class if you wish. Class dates and locations are subject to change.

Please note: Prenatal & Parenting class registration closes 48 hours before each class for planning purposes. If exceptions are needed, please call 804-323-8343.

Thank you!

* Required Fields

Name of Class: *	Choose Class BelowAmazing MotherhoodBaby BasicsBreastfeedingEarly BirdFast Track to Labor and DeliveryFor Baby's SakeGrandparentsInfant MassageLabor BasicsMarvelous MultiplesSafe RideSiblings (3-5 years old)Siblings (6-10 years old)Spanish Childbirth PreparationTiny TidbitsTour
Date of Class: *	Please double check that the date you select coincides with an actual date on the calendar for your selected class.
Location of Class: *	Choose One BelowCJW Medical Center - ChippenhamCJW Medical Center - Johnston Willis
Time Class Begins: *	Please select a time class begins9:00am9:30am11:00am12:30pm1:00pm1:30pm3:00pm4:00pm6:00pm6:30pm7:00pm Please double check that the time you select coincides with an actual time on the calendar for your selected class.
Mom-to-Be's First Name: *
Mom-to-Be's Last Name: *
Mom-to-Be's Date of Birth: *	(mm/dd/yyyy)
Partner's First Name: *
Partner's Last Name: *
Partner's Date of Birth: *	(mm/dd/yyyy)
Street Address (include Apt#): *
City, State Zip: *
(Area Code) + Home Phone: *
(Area Code) + Work Phone: *
E-mail Address: *
Due Date: *	(mm/dd/yyyy)
Doctor's Name: *
Hospital where you will deliver: *
If Sibling class, name and age of sibling:

*