Birth Boot Camp Registration
If you have any questions call Andrea at 281-788-1446 or e-mail bayoucitybirth@gmail.com
Which class are you registering for? *
Mom's Full Name *
Your answer
Partner's Full Name *
Your answer
E-mail address *
Your answer
Mailing Address
(Address, City, Zip Code)
Your answer
Mom's Phone Number *
Your answer
Partner's Phone Number *
Your answer
Estimated Due Date *
MM
/
DD
Birth Place (hospital, birth center, home) *
Your answer
Name of Doctor or Midwife *
Your answer
Do you already have children?
If yes, please briefly tell me about your birth experience(s).
Your answer
What do you hope to achieve from attending this class? *
Your answer
Do you have any health concerns I should be aware of?
Your answer
Do you plan to have a doula, family, or friends at your birth?
Your answer
Is there anything else you would like to tell me about yourself or your pregnancy?
This information will not be shared.
Your answer
How did you hear about this class? *
Your answer
Payment Method *
Your $50 deposit holds your spot in class. The remaining $275 is due at the first class (cash, check, or credit card).
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