BBC Full Series Registration
Alisa Hodge
Birth Boot Camp Instructor
OKC Birth
www.okcbirth.com
alisa@birthbootcamp.com
A non-refundable deposit of $75 is required to guarantee your spot in class and to cover the cost of materials. You may pay this via check or PayPal. Remaining balance of $275 due on or before the first night of class.
Names: *
Your answer
Address:
Your answer
Email: *
Your answer
Phone numbers: *
Your answer
Mom's age: *
Your answer
Estimated due date: *
MM
/
DD
/
YYYY
Number of children:
Your answer
Number of medicated births:
Your answer
Number of unmedicated births:
Your answer
Number of Cesareans:
Your answer
Number of VBACs
Your answer
Where are you planning to deliver your baby?
Name of Birthplace: (if not home)
Your answer
Type of Care Provider:
Name of Care Provider:
Your answer
Do you have a Doula?
If yes, who?
Your answer
Who referred you to my class? How did you hear about Birth Boot Camp?
Your answer
How do you and your partner feel about taking childbirth classes?
Your answer
Paypal email:
Your answer
A non-refundable deposit of $75 is required to guarantee your spot in class and to cover the cost of materials. You may pay this via check or PayPal. Remaining balance of $275 due on or before the first night of class.
Birth Boot Camp keeps anonymous statistics. Names are for my personal records only.
I look forward to spending time together in class! Thank you for your interest in Birth Boot Camp classes!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service