Birth Boot Camp Class Registration
By completing this form and submitting your $50, non-refundable, deposit, you will secure a spot in the class series marked below. The $50, non-refundable, deposit may be paid via PayPal (paypal.me/BethHake) or a mailed check made out to Beth Hake (Email bhake@birthbootcamp.com for my address). The remaining balance of $325 will be owed the first night of class.
What class series are you enrolling in?
Required
Mom's Name
Your answer
Partner's Name
Your answer
Address
Your answer
Email
Your answer
Phone Number
Your answer
Age
Your answer
Estimated Due Date
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/
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 (Vaginal Birth After Cesarean)
Your answer
Where are you planning to have your baby?
Required
Who is your care provider?
Required
Who can I thank for referring you to Birth Boot Camp?
Your answer
How do you feel about taking childbirth classes?
Your answer
How does your partner feel about childbirth classes?
Your answer
Make-up Class Policy: I, Beth, am an actively working doula. There is always a small possibility that I will be called to a birth on the night of class. If this happens, I will notify you with a phone call. As a class, we will agree upon a date to make-up this missed class.
Required
I understand that the $50 deposit is NON-REFUNDABLE. Once the deposit is paid and the registration form is submitted, a spot in class is reserved for you AND your student Birth Boot Camp materials are purchased.
Required
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