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Course Enrollment Information
Insight Birthing HypnoBirthing The Mongan Method
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Birthing Person's Name *
Birth Companion's Name (Spouse, partner, doula, parent,  etc.)
Home Address *
Mailing Address (If Different than Above)
Preferred Phone Number *
Alternate Phone Number
Preferred Email *
Emergency Contact Name and Phone Number
Birthing Assistant  and Relationship (Doula, friend, etc)
Care Provider Name and Title
Birthing Facility
When is baby expected?
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How many weeks pregnant will you be when starting class?
I wish to enroll for class beginning on (Date)
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I wish to enroll for class held in (location)
To reserve your spot in class, please send a non-refundable $100 deposit to Whitney via Venmo (@InsightBirthing) or  PayPal ( paypal.me/insightbirthing ). The balance ($195 for group classes, $400 for virtual private classes, $500 for hybrid private classes, or $600 for in-person private classes) is due at the first class. How are you planning on paying the balance of tuition? *
Are you a client of Davis County Midwives? If yes, discount $25 from your total tuition.  *
I hereby state that I am enrolling in the HypnoBirthing class of my own free will and with the understanding that this is a program designed to teach me to use my own natural abilities to bring my mind and my body into a state of relaxation. I further understand that the content of these classes is in no way intended to be represented as medical advice nor as a prescription for medical procedure. I am aware that I should seek the advice of a healthcare provider to answer any health-related or pregnancy-related issues surrounding my pregnancy, my labor, or my birth. *
Required
I give permission to my HypnoBirthing practitioner to use my email address for direct contact and understand that my email address will not be used in any other way. *
Required
I therefore agree that I will in no way hold the instructor of the HypnoBirthing classes or the HypnoBirthing Institute, its owner, or its representatives, responsible for any special circumstances that could arise as a result of my pregnancy, my labor, or the birth of my child, and I agree that neither I, nor any member of my family will make any claim or initiate any suit against any of the above-named parties now or at any time in the future. *
Required
Client Signature *
Date *
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