Please fill out the form below to enrol in one of my classes. If you have any questions feel free to contact me via email or phone.
hypnobirthingmacarthur@gmail.com
Christa - 0422 229 312

If you prefer to fill out an enrolment form on paper, please click on this link: http://www.naturalbirthconnection.com/Enrolment%20Form-3.pdf

Course Enrolment
Mother's Name *
Your answer
Mailing Address *
Your answer
Preferred Phone *
Your answer
Preferred Email *
Your answer
I wish to enrol in the Hypnobirthing Course on: *
Estimated Due Date (EDD) *
MM
/
DD
/
YYYY
Birth Companion Name *
Your answer
Relationship to you (e.g. spouse, partner, doula etc.) *
Your answer
Intended place of birth (name of hospital, birth centre or home)
Your answer
Care Provider Name and Title (e.g. Obstetrician or Midwife)
Your answer
Is this your 1st, 2nd, 3rd etc. baby? *
Your answer
Is this birth a VBAC (Vaginal Birth After Caesarean)? *
Is there any important information you wish us to be aware of before classes commence?
Your answer
How did you find out about our classes? *
Required
Tuition Fee: $550 Group classes
Fee includes your Hypnobirthing Australia folio and 2 x Australian Practice albums.
Payment plan available for clients with limited income.
To hold your place please submit this form with a $150 non-refundable tuition deposit.
Final payment is due 7 days prior to course start date.
***Please note: Cancellations/refunds cannot be accepted within 7 days of the course start date. At this time, refund (of the $400 balance) can only be given in exceptional circumstances.***
Payment can be made via direct deposit or PayPal.
Direct Deposit Details:
Bank: ANZ
BSB: 012-556
A/C: 587550123
Name: Christa Buckland

If you wish to pay by credit card, the PayPal link is located on our website: www.hypnobirthingmacarthur.com

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