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!
Hi there! I'm so excited to meet you. What's your name? *
Your answer
What's your partner's name? *
Your answer
Email *
Your answer
Address *
Your answer
Phone Number *
Your answer
How can I best contact you? *
Required
How old are you? *
Congratulations on your pregnancy! When is your estimated due date? *
MM
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DD
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YYYY
How many kids do you have? *
Have you had a medicated birth?
Have you had a unmedicated birth?
Have you had a cesarean?
Have you had a VBAC?
Where are you planning to have your baby? *
Who is your care provider? *
Your answer
How do you feel about taking a childbirth class? *
Your answer
How does your partner feel about taking a childbirth class? *
Your answer
Which class(es) would you like to register for? *
Required
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?
Your answer
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.
Your answer
How did you hear about my Birth Boot Camp classes? *
Referred by someone personally? Who can I thank?!
Your answer
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