Birth Boot Camp Student Registration
Welcome to Birth Boot Camp! I'm so pleased that you've decided on the Birth Boot Camp curriculum. It's modern, up to date, and comprehensive, and I'm confident it will give you the tools you need to achieve the natural birth you desire.
Mom's Full Name *
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Partners Full Name *
Your answer
Address *
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City *
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Zip Code *
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Email *
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Cell Phone Number *
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Text Okay? *
Age *
Your answer
Estimated Due Date *
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# of Medicated Births *
Your answer
# of Unmedicated Births *
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# of Cesarean Births *
Your answer
Care Provider *
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Birth Location *
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How do you feel about taking childbirth classes? *
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How does your Partner feel about taking a childbirth class? *
Your answer
Any concerns or fears about this pregnancy?
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What I would like to learn in this class is...
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Please briefly explain your previous pregnancy/birthing experience(s), if applicable
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How did you hear about Birth Boot Camp? If it was a specific person, please use their name so I can thank them. *
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What classes are you interested in? *
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