ten toes Application

Name (required)

Home Address

City State Zip Code

Email (required)

Phone (required)

Coach (Name of person attending classes with you)

Name of Child (for Sibling Prep only) Age of Child

Due Date

Who Can We Thank For Your Referral?

Obstetrician

Hospital of Delivery

Please check the applicable boxes and fill in your requested dates (please refer to www.tentoes.org for more info)

Childbirth Series    Applicable Dates

   4 Sessions $200

   3 Sessions (26 weeks, 34 weeks, 35 weeks) $175

   2 Sessions (34 weeks, 35 weeks) $150

   1 Condensed Weekend Session (34 and 35 week material only) $175

Other Classes

Private Childbirth Classes Date $250

Breastfeeding 101 Date $50

What To Do Your First 24 Hours Alone! (Baby Care) Date $50

ten toes' Big and Little Helpers (Sibling Prep Class) Date $40

ten toes' Big and Little Helpers with Addt'l Siblings Date $10

Infant/Child CPR Date $75

CPR Party Date $80

Private Lactation Consultation on Staten Island Date and Time $175

Private Lactation Consultation off Staten Island Date and Time $200

	4 Sessions	$200
	3 Sessions (26 weeks, 34 weeks, 35 weeks)	$175
	2 Sessions (34 weeks, 35 weeks)	$150
	1 Condensed Weekend Session (34 and 35 week material only)	$175

Private Childbirth Classes	Date	$250
Breastfeeding 101	Date	$50
What To Do Your First 24 Hours Alone! (Baby Care)	Date	$50
ten toes' Big and Little Helpers (Sibling Prep Class)	Date	$40
ten toes' Big and Little Helpers with Addt'l Siblings	Date	$10
Infant/Child CPR	Date	$75
CPR Party	Date	$80
Private Lactation Consultation on Staten Island	Date and Time	$175
Private Lactation Consultation off Staten Island	Date and Time	$200