Childbirth Class Registration Form

Please provide the following information:
Mother's First Name 
Mother's Last Name 
Address  
City  
State  
Zip  
Daytime Phone  
Email  
Due Date  
Mother's Physician  
Will you be attending the Breastfeeding Class?  

Cost is $50.00 payable in advance.  Please send check to: Kosciusko Community Hospital, Education Department, 2101 East DuBois Drive, Warsaw, IN 46580. If paying by credit card please call (574) 372-7605.

Prenatal classes will take place in the Administrative Class Room located in the Administration Building from 7:00 p.m. until 9:00 p.m.  Class size is limited, so please register early.  

If you need to change your class date or cancel your registration, please click here to email Kathy Kostro.

In the event that something changes concerning the class, you will be contacted.

General Internet communication is inherently not secure. For this reason, we highly recommend that data considered confidential or private in nature not be submitted on this form. (e.g., Social Security Numbers, Diagnosis Information, Credit Card Numbers, etc.)