healthsource solutions employee

As part of your employee wellness program you are able to take up to 3 Amma Prenatal and New Parent classes within a calendar year at no cost to you. Please fill out the form below with specific class selections, dates and locations. We will then send you an email confirmation(s) for your classes. You must complete the form in full or we will be unable to process your request. If you have questions or are unsure of class dates and times please note that in the comments section below and we will give you a call.

Please note: If we are unable to verify your employment you will be responsible for the tuition(s) of your class(es).

You must view the Waiver here and agree in the below form.

If there is no “sign up” button next to the class, then that particular class is full. Please select another option.

Eligible employees can choose from the following classes in online, in person or virtual format:

complete this form to sign up for a class

"*" indicates required fields

First Name*

Baby’s birth location*

Last Name*

I have read the above waiver and agree.*

I have read the above waiver and agree.

Due Date*

How did you hear about Amma?*

Email Address*

Phone*

Employee Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Class Selections (Class name, date, time).*

This field is hidden when viewing the form

Boulay Employee Number*

HealthSource Solutions Employee Benefit

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