Mindful Birth and Parenting Registration
Welcome to Mindful Birth!

To register, fill out the form below and send in a deposit to hold your space.

I highly recommend the 8-week series, if at all possible. If you have to miss a session or two, it's not a problem. Let me know and I can give you options for making up the missed sessions.

If you would like further information about classes before registering, please email info@mindfulbirthny.com. Or call 347.276.2819, especially if you would like to discuss mindfulness and labor preparation.

These classes offer practical, hands-on preparation for birth and parenting for women and birth partners who are looking to approach labor and parenting as a team. The goal is for you and your partner to feel calm, well-prepared, and connected as you approach your child’s birth and the changes coming to your lives with parenthood.

I bring fifteen years of experience to an intimate setting that welcomes families birthing at home, in birth centers or hospitals.

I hope you can join us!

Warm Regards,
Mary Esther Malloy, MA

Which class series would you like to attend? *
Expectant Mother's Personal Info
First and Last Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Full Postal Address *
Your answer
Partner's Personal Information
First and Last Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Full Postal Address (if different from above)
Your answer
About the Baby and Birth
Estimated Due Date *
MM
/
DD
/
YYYY
Midwife or Doctor? *
Name of Midwife or Doctor
Your answer
Name of Doula if using doula care
Your answer
Birth Location *
If planning on a birth center or hospital, which one?
Your answer
Is this your first baby? *
If this is not your first baby, what are the ages of your older children?
Your answer
How did you hear about this class? *
Your answer
About You
These are some questions that will help me get to know you. Your responses can be super brief or pages long - however you would like to respond!
How is your pregnancy going?
Your answer
How are you feeling about your upcoming birth?
Your answer
How are you feeling about your doctor/midwife and where you're planning to give birth?
Your answer
Will you be inviting others to join your birth team, such as mother, friend, sister, doula, etc.?
Your answer
How do you see yourself coping well with your labor?
Your answer
How ready do you feel to become a parent (or welcome yet another little one)?
Your answer
Do you have any particular fears or concerns regarding birth or parenting that I should know about?
Your answer
How was your previous birth experience (if applicable)?
Your answer
Do you have any medical challenges I should be aware of?
Your answer
What have you found to be a particularly inspiring resource for birth and/or parenting?
Your answer
Deposit Payment and Agreement
To confirm your enrollment, please send a $100 non-refundable deposit for childbirth classes or $75 payment for refresher-specific classes via one of the methods below. Please email maryesthermalloy@gmail.com with any questions.
To confirm your enrollment, please send a deposit of $100 or request an invoice. The total fee for the childbirth class is $395 for weekend intensive, $495 for series, $545 for series + retreat day. The balance is due at the first class unless other arrangements are made. Refresher class students, please pay $75 in full for a refresher-specific class. The refund policy is as follows: the deposit is non-refundable. If after the first class you need to cancel, the initial deposit will be retained and any balance paid will be refunded, minus a $50 cancellation fee and $35 materials fee, unless the workbook is returned. Subsequent refunds/deductions after the first session will be not be available. Thank you for your understanding. Please let me know in writing if you would NOT like to be included in an email contact list with your classmates, which will be shared during and/or at the end of the class series. Also please let me know in writing if you do NOT approve my use of photographs taken during class for my website, your group's Facebook page, and/or other promotional materials. *
Required
How will you pay the $100 childbirth class deposit or $75 refresher fee? *
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