Birth Boot Camp Class Registration Form
Please complete this form and I will be in touch with you within 24 hours to complete the final steps of your registration. Thank you!

Class policies and FAQs: https://treasuredbirthservices.com/birth-boot-camp-classes/policies-faqs/
Sign in to Google to save your progress. Learn more
Hi there! I'm so excited to meet you. What's your name? *
Preferred Pronouns? *
What's your partner's name?
What's your partner's preferred pronouns?
Email *
Mailing Address *
Phone Number *
How old are you? *
Congratulations on your pregnancy! When is your estimated due date? *
MM
/
DD
/
YYYY
How many kids do you have? *
Have you had a medicated birth?
Clear selection
Have you had a unmedicated birth?
Clear selection
Have you had a cesarean?
Clear selection
Have you had a VBAC?
Clear selection
Where are you planning to have your baby? *
Who is your care provider? *
Do you have a doula? If yes, what is their name? *
How do you feel about taking a childbirth class? *
How does your partner feel about taking a childbirth class?
Which class would you like to register for? *
Coupon Code?
Did you pay the class deposit (or total)? *
The deposit is due at registration, to secure your spot in class and order your class materials. However, you may pay for the class in full at registration. Payment can be sent via Venmo (@treasuredbirth) or a PayPal invoice can be sent to your email.
Additional Information
Please tell me what you're most looking forward to about taking a Birth Boot Camp class, and anything specific you're hoping to learn. What are your goals for this birth? Anything else you would like me to know?
Photo Release *
By typing my name below, I grant to Hanan Webster of Treasured Birth Services the right to take photographs of me/us. I authorize her to use and publish the same in print and/or electronically. I agree that she may use such photographs of me/us, with or without my name, for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.
How did you hear about my Birth Boot Camp classes? *
Referred by someone personally? Who can I thank?!
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy