Birth Boot Camp Class Registration
Once this form is submitted, I will send you a PayPal Invoice for the $50, non-refundable deposit. The remaining $325 is due the first night of class, and/or can be submitted via PayPal.
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 *
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 (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
Would you like the opportunity to apply for a Birth Boot Camp scholarship?
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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