Birth Boot Camp Class Registration
Once completed, I will be in touch to confirm and collect your registration fee! Thanks!
Email address *
Name *
Partner's name *
What is your address? *
What is a phone number where you can best be reached? *
How did you hear about my classes? *
Which class would you like to register for? *
Where do you plan to birth your baby? *
Who is your provider? *
What is your estimated due date? *
MM
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DD
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YYYY
How do you feel about taking childbirth classes? *
How does your partner feel about taking childbirth classes? *
In what ways have you prepared for childbirth during this pregnancy? (Books, movies, groups, etc) *
If you are comfortable sharing, was there any trauma in your past that could effect your labor and/or birth?
Do you have any questions for me or anything you'd like me to know?
I understand that I will not be considered registered for the above selected class in which I am registering for until I have paid the listed deposit fee outlined in the class description. I understand that this fee is nonrefundable. I understand that the remaining balance of the class is due at the first class and is also nonrefundable. I understand if this is an issue, I need to speak with Kelly Lipscomb prior to the first class session and make arrangements. *
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