Reboot Refresher
This form is for those wanting to take a Reboot Refresher class.
Birthing Persons Name: *
How do they feel about taking a birth class?
Birth Partners name: *
How do they feel about taking a birth class?
Email: *
Phone Number *
Due Date *
MM
/
DD
/
YYYY
Birth location *
I would prefer my class location to be *
Address
3 dates/times this class would work for me *
Tell me a little (or as much as you want) about previous births. *
What are you hoping to get out of this class?
Who is your care provider?
How did you hear about this class?
Is there anything else you want me to know?
I understand that I will not be considered registered for the Reboot Refresher class, nor will any arranged date be saved, 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 the date of the class. *
Thank you for your interest! When this form is received you will get an email to discuss a date and payment.
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