Birth Boot Camp Comprehensive Class Series
Class Dates: Every Saturday January 5 - March 9, 2019
Class Time: 10am-12:30pm
Location: The Happy Mama Place, Wilkes Barre Pa
1325 North River Street, Plains, Pa 18702 (Tuft-Tex Complex) (Your GPS may say Wilkes Barre)
Contact Info: Heather Whitcomb (570)542-2229, Heather@ButterflyDoula.com,
Cost: $350

Full class description and other class options can be found at www.ButterflyDoula.com/childbirth-classes/

Financial Agreement
The cost of this class is $350. A non-refundable deposit of $75 is due with your registration. Your completed registration form AND paid deposit are required to hold your space in the class series. The deposit for this class is NON-REFUNDABLE. The balance is due at the beginning of the first class. You may pay by cash or check by mail, paypal or with a credit card in person at the first class. Any refunds given after the first class will be at the discresion of the instructor. By completing this form you are agreeing to these financial terms.

If you refer another couple to the class you can earn $25 towards your class fee. Refer 2 or more couples to class and save $50! The couples that you refer must list your name on the registration form and pay their deposit and blanace by the first class. All credits will be issued after the first class of the series is complete. A maximum of $50 can be earned toward your class fee.

Please make checks payable to Butterfly Birth Services LLC.

Payments can be mailed to,
Heather Whitcomb
33 Elmer St
Ashland, Pa 17921

Paypal address Heather@ButterflyDoula.com

Email address *
Mother's Name *
Your answer
Partner's Name *
Your answer
Phone Number *
Your answer
Address *
Your answer
Estimated Due Date *
MM
/
DD
/
YYYY
Where do you plan to give birth? *
Your answer
Who is your care provider? *
Your answer
What do you hope to learn in ths class? *
Your answer
How did you find out about this class? *
If you were refered by someone please list them so that I can thank them!
Your answer
Please list any food allergies/restrictions that I should be aware of. *
Your answer
Please select your payment method. Please make checks payable to Butterfly Birth Services LLC. *
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