Childbirth Education Classes Registration Form
1. Review the class dates at: chsbuffalo.org/childbirthclasses or call (716) 447-6205 if you do not have internet access.
2. Complete the form below, select your classes, and list the desired date with an alternate date.
3. Send your form by: Mail: Catholic Health’s HealthConnection • 144 Genesee Street, 5th Floor • Buffalo, NY 14203
Fax: (716) 706-2545
Email: [email protected]
4. Confirmation of class registration will be mailed to you at the address you provide.
Childbirth Education Classes
ALL REGISTRANTS: Please fill out this section. (For CPR Certification or Grandparents classes, fill out a separate form for each attendee.)
Name:
Date of Birth:
Last 4 digits of SS#:
Address: City:
State:ZIP:
Phone:
Email:
Last
First
Marital Status:
Winter Warning:
In cases of severe winter weather and road
closures, please listen to local radio stations for
announcements of class cancellations.
Race:
Ethnicity:
Employer: If You Are Unable to Attend a Class:
Please call Catholic Health’s
HealthConnection at
(716) 447-6205
to cancel.
Emergency Name and Phone:
Primary Physician:
Childbirth Classes • Preparing to Breastfeed • Marvelous Multiples
Baby Talk Parenting • Sibling • Preparation • Hospital Tours
Office Location:
EXPECTANT MOMS: Please also fill out this section.
Classes Sizes Are Limited.
Register Early!
Where do you plan on delivering?  Sisters Hospital  Mercy Hospital  Mount St. Mary’s Hospital  Other:
Previous/Maiden Name:
Due Date:
Date of Last Menstrual Period:
For questions, additional registration
forms, or more information on any of
our childbirth classes, visit us online at
chsbuffalo.org /childbirthclasses or call
Catholic Health’s HealthConnection at
(716) 447-6205.
OB Provider’s Name: Office Location:
INSURANCE INFORMATION: All registrants please fill out this section.
 No Insurance/Self Pay
Primary Insurance:
Policy Number:
Subscriber:
Group:
Subscriber’s Employer:
Subscriber’s Date of Birth:
Secondary Insurance:
Policy Number:
Subscriber’s relationship to patient:
Plan:
Our Mission
Medicare Number:
Medicaid Number:
Newborn Medicaid Number:
Why we exist.
CHOOSE YOUR CLASSES: Check the classes you wish to take. Visit chsbuffalo.org or call 447-6205 for the available
We are called to reveal the healing
love of Jesus to those in need.
Our 2020 Vision
dates and times. Write your first and second choices of dates in the appropriate space.
2nd Choice:
1st Choice:
❑ Prepared Childbirth
❑ Grandparents
❑ Lamaze Focus
❑ Car Seat Safety
❑ Prepared Pregnancy
❑ Community Class
❑ Prepared Cesarean
❑ Preparing to Breastfeed
❑ Marvelous Multiples
❑ Baby Talk
2nd Choice:
What we are striving to do.
Inspired by faith and committed to
excellence, we will lead the transformation
of healthcare in our communities.
# of seats you are bringing:
❑ Infant CPR/First Aid
❑ Childbirth Refresher
❑ High Risk Pregnancies
❑ Parenting in the NICU
❑ Sibling Class
names & ages of siblings:
(716) 447-6205 l chsbuffalo.org/childbirthclasses
11955 - REV 9/22/16
1st Choice:
11955 - REV 9/22/16
Select the Classes:
(716) 447-6205 l chsbuffalo.org/childbirthclasses
Childbirth Education Classes
Getting ready for a new baby is a fun and exciting time. Catholic Health is
happy to provide classes to make this time as easy as possible for you and
your family. Come and join us and find out what to expect during pregnancy,
labor and delivery, and after your new bundle of joy arrives home!
Prepared Pregnancy – CLASSIC
Prepared Childbirth – COMMUNITY
OMG! Two lines on the stick! Now what? This
comprehensive class gives you tools to keep yourself
and your new baby as safe and healthy as possible
throughout pregnancy. After coming to our two
evening series or one weekend day class, join us for
monthly support group meetings on different topics of
interest during pregnancy.
Class cost is $30 per couple.
These three-hour classes cover all the basic topics in
our longer classes. Bring one or two people with you
and prepare to laugh and move your way through a
fast paced, lecture-free learning experience! Basic
Infant CPR and Car Seat Safety activities are included.
(These can be taken instead of or with the lecture
based series.)
Class cost is $30 per Mom and 2 guests.
Prepared Pregnancy – COMMUNITY
Prepared Childbirth – REFRESHER
A hands-on class to cover what to expect during
pregnancy. This is a fast paced and interactive class
for Mom and up to two friends or support people.
May be taken instead of or with the CLASSIC class
(see Prepared Pregnancy CLASSIC). No lecture at
all, so bring questions and be ready to participate in
activities!
Class cost is $20 per Mom and 2 guests.
As medical care is constantly changing, we
recommend coming to the full childbirth class,
however, if you have had a baby before and want
the shortened version, please come at 10:30 – 4 on
our all day classes, or the two middle weeks of our
four week series! This will shorten your class time
and still go over active labor and delivery. Please let
HealthConnection know when you register for class
that you are taking classes as a Refresher.
Class cost is $30 per couple.
Prepared Childbirth – CLASSIC
Childbirth classes are perfect for any expectant parent
who wants to know what will happen in labor and
delivery and beyond. Our fun and interactive classes
will include tips on making your pregnancy easier,
labor and delivery facts, and recovery at home. We
will also talk about care for both Mom and baby after
you leave the hospital. A tour is included! Please dress
comfortably and prepare to have fun while learning.
Class cost is $60 per couple.
Lamaze Focus
These classes are geared towards parents who desire
additional Lamaze focus for natural child birth. These
classes have four sessions and the fifth is a tour
at Sisters. All other topics covered in our standard
Prepared Childbirth Classes are also covered.
Class cost is $70 per couple.
Prepared Cesarean Delivery
For parents who know they will be scheduled for a
Cesarean Delivery, this class covers what to expect.
We cover all the information in our Prepared Childbirth
CLASSIC class, but without the labor section! We also
discuss recovery at home, pain control techniques,
and answer questions about the surgical delivery. A
tour is included.
Class cost is $25 per couple.
All class times and locations are available at
chsbuffalo.org or by calling (716) 447-6205.
Baby Talk
Marvelous Multiples
The arrival of multiples is amazing! This class is
intended to add to the Prepared Childbirth Class or the
Prepared Cesarean Delivery class for parents expecting
more than one new arrival. This class will give you
more information about what is happening both during
your pregnancy and tips from moms who have been
there! We tour the NICU during this class, but not labor
and delivery.
Class cost is $25 per couple.
High Risk Pregnancies and Deliveries
This class will cover special concerns during a high
risk pregnancy. We will cover medical care, what to do
at home, what to expect, and before and after delivery.
Ask questions, become more informed, and be an
active part of your healthcare team!
Cost is $20 per couple.
Parenting a Baby in the NICU
If you have been told you are at a high risk for early
delivery or your baby is likely to be in the NICU for a
while, this class is for you. We will take a tour of the
NICU, discuss care of a baby in the NICU, and discuss
parenting tips for while your baby is at the hospital.
Many parents say seeing the NICU and having their
questions answered beforehand greatly decreases
fears and anxiety!
Cost is $20 per couple.
Preparing to Breastfeed
A lactation consultant will review common
questions and concerns regarding the first weeks of
breastfeeding. A good start makes the first few weeks
much easier, so come and prepare with our expert
instructors. Both parents are welcome or feel free to
come with a friend!
Cost is $25 per couple.
Sibling Classes
Introduce your 3-8 year old child or children to being
a big brother or sister. Parents accompany children
on a guided tour of the nursery, view Mom’s room and
see new babies through the nursery window. Children
explore, with the help of a doll, how newborns are
held, fed, diapered, and bathed.
Class cost is $15 per family.
Tours
Tours are available for all expectant parents. If you
are not attending a class (where tours are provided)
please call Catholic Health's HealthConnection at
(716) 447-6205 to sign up for a tour. As space is
limited, please call at least a month before your
due date!
This enjoyable class helps make those first few weeks
less stressful! We discuss care of your newborn,
health concerns to watch for, and challenges all new
parents face. There is plenty of both discussion time
and practice time with our lifelike dolls.
Class cost is $20 per couple.
Prepared Pregnancy Support Group
Grandparents Classes
It is amazing how much changes! Grandparents
are experts in so many areas of child raising, but
if you would like a refresher or just a look at what
recommendations have changed, please join us.
This class covers new infant care, (car seat and sleep
safety), supportive care for the new parents, and fun
activities to prepare for the arrival of your precious
grandchild. Please fill out a separate registration form
for each person taking this class.
Class cost is $10 per person.
Infant and Child CPR Certification/First Aid
This practical class will prepare you for emergency
situations. We will cover how to respond if a child is
choking, drowning, has an injury, or needs CPR. Since
infants grow so quickly, we will cover both infant and
child age groups. This class includes American Red
Cross CPR certification. Please fill out a separate
registration form for each person taking this class.
Cost is $45 per person.
Infant and Child CPR
This shorter class is for those who may not need
certification or can’t fit the longer classes into their
schedule. Including choking, drowning, CPR, and use
of an AED, this class covers the basics but does not
include certification.
Cost is $25 per couple.
The support groups will meet monthly. Each night
will have an educational theme and the opportunity
to laugh and share with other expectant parents. A
childbirth educator will always be available to answer
questions at these events. (These meetings are not
intended to be a substitute for childbirth classes.)
Car Seat Safety
Proper car seat use saves lives! Many parents are
shocked to find out that car seats are usually used
incorrectly. Come to class where we will have both a
class portion and a one-on-one car seat fitting with
a certified Child Passenger Safety Tech. If you have
a car seat, please bring your seat so you can learn
how to use it most effectively.
This class is free, but donations are gratefully
accepted to help other children in need of safe seats!
Higher Risk Pregnancy Support Group
For Moms and partners who are diagnosed as higher
risk, come meet other families with similar challenges.
When we stand together, we are always stronger!
Each evening will feature a different topic important
to higher risk pregnancies. Laughter and sharing will
always be included!
Gestational Diabetes
Instruction on diabetes self-care and nutrition is
available. Call HealthConnection at (716) 447-6205
to learn more or schedule an appointment.
Ready, Set, Parent!
EPIC (Every Person Influences Children) will provide
positive parenting preparation for pregnant and new
parents. In this session you will learn about the three
"Terrific T's" of parenting: Taking Care of Yourself as a
Parent; Tuning Into Your Baby's Needs; and Teachable
Tips for Early Brain Development.
These classes are free, but
registration is required. Please
call (716) 332-4127 to register.
Health Insurance Coverage
When registering for class, this form will also be used to pre-admit you to the hospital. Pre-admitting will decrease
your paperwork when you arrive in labor!
All Catholic Health hospitals will bill your insurance company for many of your classes. Most insurers (including
Medicaid) cover the cost of most classes, but please check to make sure that your insurance does. If your
insurance does not cover all of the cost, you may receive a bill for the amount not covered. If costs are an issue,
please call (716) 601-3600 for billing options and assistance.