Sign up form Birth Class

    Name (first name and last name)

    Date of birth

    Name partner (first name and last name)

    Date of birth partner





    Phone number

    How did you find Lytse Pop? By whom or what? (more options possible)

    Choose course type

    We are NOT available on (one option possible)

    Due date

    Pregnant for the

    Pregnancy supervised by midwife practice (name and place). Please do mention the hospital too if you are (also or only) supervised by a gynecologist.

    Course of pregnancy (short description)

    Questions or extra message (optional)

    We accept terms and conditions regarding the Birth Class Birthing Together.
    Click here to read terms and conditions (in Dutch only).