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
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Phone Number (cell preferred) *
123-456-7890
Your answer
What's your address? *
ex: 123 Sharp St., Austin, TX 78757
Your answer
What's your Estimated Due Date? *
MM
/
DD
Which statement best describes you?
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's your OB / Midwife?
Your answer
Do you have a TV we can use for the class content? *
Does your TV have an HDMI input? *
What Month do you prefer to take your class(es)? *
ex: early November; late January; March; etc.
Your answer
Of the following options, please select all days/times that you are generally available. *
Required
What's your 1st preference for day/time?
ex: Saturday 1pm or Sunday 1:30pm
Your answer
What days/times never work for you? *
ex: Tuesday evenings; Sunday mornings; Thursdays 7p -10p; M-F 8-5, etc.
Your answer
Any specific dates that are off limits?
Ex: your Baby Shower, a vacation, etc.
Your answer
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.
Your answer
If you selected 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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