Childbirth Education Booking Form

Name __________________________
DOB _____________
Due Date _____________
Place you are giving birth ______________________________
Previous number of children________
Dates attending ____________________
Will you be bringing a support person? ___________
If yes, what is their relationship to you? ______________
What is your support persons name? _______________
What are you hoping to gain from Childbirth Education classes? ________________________________________________________________________________________________________________________________________________________________________________________________________________________

Payment details
Courses are $110 ($80 if you have a friend booking in too) and a deposit of $50 is required at time of booking, the deposit is deducted from your balance.
Balance is due before the first class starts either via bank deposit or cash at the beginning of the first class.

Payable to:
A Rainbow Doula
BSB: 06370
Account number: 10321915
Please use your surname as a reference