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Contact Detials
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Your Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Ethnicity
*
Mobile
*
Occupation
*
Email
*
*Please select an email address that will be accessible during any maternity leave.
Partner's Name
*
First
Last
Partner's Gender
*
Male
Female
Partner's Date of Birth
*
Partner's Ethnicity
*
Partner's Occupation
*
Partner's Email
*
Address
Address
*
Street Address, Suburb, City, Post Code
Postal Address
*
*If your postal address is differnt.
Membership
Membership Type
*
Full Membership Package - $325
Antenatal Membership Package - $295
More information on membership types
here
.
Course Code
*
AN2301 Sun 22nd Jan & Sun 12th Feb
AN2302 Wed 18th Jan to 22nd Feb
AN2303 Sun 12th Mar & Sun 26th Mar
AN2304 Wed 8th Mar to Wed 12th Apr
AN2305 Sun 7th May & Sun 21st May
AN2306 Wed 10th May to Wed 14th June
AN2307 Sat 2nd July & Sun 16th July
AN2308 Wed 19th July to Wed 23rd Aug
AN2309 Sun 10th Sept & Sun 24th Sept
AN2310 Wed 13th Sept to Wed 18th Oct
AN2311 Sun 5th Nov & Sun 19th Nov
AN2312 Wed 1st Nov to Wed 6th Dec
Other
Payment
Payment Options
*
Bank Transfer
PayPal (also includes debit & credit card payments)
Payment information will be displayed on the next page after submitting your membership form.
Antenatal
Your Due Date
*
Lead Maternity Carer
*
Home or Hospital?
*
*If hospital, which one?
Are there any special circumstances about you or your antenatal history that you would like us to be aware of (miscarriages, previous pregnancies, etc)? This information will be strictly confidential to our Childbirth Education Team.
Comments
*
How did you hear about Parents Centre?
*
Lead Maternity Carer/Dr
Friend/Family
Facebook
Internet (Google)
Advertising (Print, Email, etc)
Other
Do you wish to receive offers from carefully screened companies whose products or services we think you may be interested in?
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Yes
No
Are you interested in volunteering for Parents Centre now or in the future?
*
Yes
No
If interested, please indicate when you would like to be contacted.
*
e.g - 1 month, 3 months, 6 months
This information will be used for the purpose of Parents Centre membership and courses and the compilation of national statistics. Individuals may view and correct information about themselves by contacting the membership officer for their Centre.
Please note, your membership will be activated about approx 2 weeks prior to the commencement of your course to ensure you can maximise our membership benefits when you have your child.
If you haven't heard back from us within a few days, please check your junk/spam email folder as our replies can sometimes end up in there in error.
Cancellations
– A minimum of 28 days notice prior to the start of a course is required. Cancellations after this date will not be refunded. Cancellations prior to 28 days will incur a $25 administration fee. If you are no longer wishing to attend antenatal classes please contact us to advise.
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