Birth Boot Camp Classes
Student Registration Form
Email address *
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
Birth History *
Where are you planning to birth? *
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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