Membership Form

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

Membership

Membership Type *

More information on membership types here.

Course Code *

Payment

Payment Options *

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 *

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.

Bays North Harbour Membership Form

Contact Detials

Address

Membership

Payment

Antenatal