DBL Baby Language Workshop Registration
*
indicates required
Name:
Email:
Comment:
First Name
Last Name
Email Address
*
Phone Number
Is your partner coming?
Yes
No
Unsure
Workshop Date
Tuesday April 30th 6:00 pm Dartmouth
Saturday July 20th 1:30 pm Brickyard Health
Saturday October 12th 10:00 am Brickyard Health
Please contact me, I can't make this dates.
When is baby expected / when was baby born?
Preferred method of payment
*
Cash
E-transfer
Cheque
Credit Card
Other
How did you hear about us?
A friend referred me
My care provider referred me
My Doula referred me
I saw a poster/pamphlet with your information
Internet search
Facebook
The Happy Baby Expo
Other
