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Birth Boot Camp Classes
Student Registration Form
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* Indicates required question
Email
*
Your email
Mother's first and last name
*
Your answer
Partner's first and last name
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Age
*
Your answer
Estimated Due Date
*
MM
/
DD
/
YYYY
Number of Children
*
Your answer
Class signing up for
Column 1
Comprehensive 10 week Class
Hospital Birth Class
Comfort Measures Workshop
Reboot Refresher
New Recruit Class
Out of Hospital Birth Class
Column 1
Comprehensive 10 week Class
Hospital Birth Class
Comfort Measures Workshop
Reboot Refresher
New Recruit Class
Out of Hospital Birth Class
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Birth History
*
Medicated
Unmedicated
Cesarean
VBAC
None (First-Time)
Where are you planning to birth?
*
Home
Birth Center
Hospital
Other:
Who is your current care provider?
*
Your answer
How did you here about Birth Boot Camp, or Compassionate Birth Services, LLC?
*
Your answer
How do you feel about taking childbirth classes?
Your answer
How does your partner feel about taking childbirth classes?
Your answer
A deposit is required. You will receive an email with specifics. Your remaining fee will be due at the beginning of the first class.
A copy of your responses will be emailed to the address you provided.
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