Hypnobirthing Australia Classes
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.
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

Email address *
Course Enrolment
Mother's Name *
Your answer
Mailing Address *
Your answer
Preferred Phone *
Your answer
I wish to enrol in a: *
Please select the group course date you wish to attend or select 'other' if booking a private session(s) with me: *
Estimated Due Date (EDD) *
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)? *
I teach group classes in my home. In order to ensure that I can provide a safe and comfortable environment for all please let me know if you have any dietary requirements, allergies or other needs.
Your answer
Is there any important information you wish me to be aware of before classes commence?
Your answer
How did you find out about my classes? *
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 (preferred) or PayPal.
Direct Deposit Details:
Bank: ANZ
BSB: 012-556
A/C: 587550123
Name: Christa Buckland

If you wish to pay by credit card please click here: https://www.paypal.me/ChristaBuckland

A copy of your responses will be emailed to the address you provided.
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