Hospital Series Registration
Name *
Your answer
Partner's Name *
Your answer
Address
Your answer
Email *
Your answer
Phone Number *
Your answer
Due Date *
MM
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DD
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YYYY
Which series are you registering for?
How did you hear about me/Birth Boot Camp? *
Your answer
Who is your care provider?
Your answer
How do you feel about taking a childbirth class?
Your answer
How does your partner feel about taking a childbirth class?
Your answer
What do you hope most to learn in our series?
Your answer
Are you or your partner allergic to any foods or scents, such as essential oils? What is your allergy? *
I understand that I will not be considered registered for the Training for an Amazing Hospital Birth series in which I am registering for until I have paid my deposit of $50. I understand that this deposit is non refundable. I understand that the remainder of the balance is due during the first class, and is non refundable. I understand that if this is an issue I need to speak to Carol Meadows prior to the first class session and make arrangements. *
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