Private Session Registration Form
Please fill out this form if you're interested in taking a private class with Swaddled Prepared Childbirth.  I will get back with you via email within 72 hours to discuss further details on scheduling your private session. Filling out as much of this form as possible will prevent excessive back-and-forth emails about scheduling. Please note that this form is only a tool to help us find a mutually agreeable day & time. We will further discuss the specifics and set a time/date via email after completion of this form. Thanks for your interest in taking one of my classes! ~Kristen
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First Name *
Last Name *
Email Address *
Phone Number (cell preferred) *
123-456-7890
What is your address? (so I can get to your house for the class) *
e.g., 123 Baby Coming Soon Blvd., Unit A, Austin, TX 78757
What's your Estimated Due Date? *
MM
/
DD
Which statement best describes you?
Clear selection
What class(es) are you interested in taking? *
Select all that apply.  You may take more than 1 class.  Select 'Hybrid' if you want to pick and choose certain topics from any of the classes offered instead of taking the entire class(es) as offered.  
Required
Who is your OB / Midwife?
Do you have a TV in your home that we can use for part the class? *
Does your TV have an HDMI input? *
What Month do you prefer to take your class(es)? *
e.g., early November; late January; March; etc.
Of the following options, please select all days/times that you are generally available. *
Required
What's your 1st preference for day/time?
e.g., Saturdays mid-morning; Sunday afternoons; Tuesdays 3pm; Thursdays late evening; Friday mornings; etc.
What days/times never work for you? *
e.g., Tuesday evenings; Sunday mornings; Thursdays 7p - 10p; M - F 8 to 5; etc.
Any specific dates that are off limits?
e.g., your Baby Shower, a vacation, etc.
How did you hear about Swaddled Prepared Childbirth?
Anything else you want us to know?
Please also indicate here if you are open to a weekday evening class starting around 6pm.
If you want a Hybrid class, please select the topics you want instruction on from the list below.
Swaddled Prepared Childbirth provides information intended for educational purposes only. Always consult with your health provider if you have any concerns about your health or the health of your baby. *
Required
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