Class Registration Form
Please complete this form and I will reach back out to you in 24 hours to finalize your registration!
Hello! What's your name? *
What is the name of your partner?
What city do you live in? *
Phone number (Text Y/N?) *
How do you prefer I contact you? *
Congratulations on your sweet baby! When is your estimated due date? *
Please tell me a little about your history with birth. First time Mama? VBAC Mama? Unmedicated or Medical birth experiences? *
Where are you planning on having your sweet baby? *
Who is your care provider? *
How do you feel about taking a childbirth education course? *
How does your partner feel about taking a childbirth education course?
Which class(es) are you interested in registering for? *
Please tell me what excites you most about taking a Birth Boot Camp class and what your goals are for your birth? *
Photo Release
I LOVE to take pictures in some of my classes!  
Typing my name below grants Shelby Tolar of Love to Mama the right to take photographs of me/us. I authorize her to use and publish them in print and/or electronically. I agree that she may use such photographs of me/us, with or without my name, for any purpose that coincides with her business, Love to Mama. *
How did you hear about Love to Mama? *
Who can I thank for referring you to me?
As your support, I want you to know that during labor and birth, emotions associated with prior trauma (such as physical, emotional, or sexual abuse, reproductive trauma, pregnancy loss, etc) can come to the surface. As your educator, it may be helpful for me to be aware of this history and what your triggers are or may be so that I can speak cautiously and with the empathy and sincerity that you deserve. As with all of your information, any information you share will be kept confidential.
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