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? *

Phone Call

Text Message

Other:

Required

How old are you? *

under 18

18-29

30-39

40-49

Congratulations on your pregnancy! When is your estimated due date? *

YYYY

How many kids do you have? *

Have you had a medicated birth?

Yes

Have you had a unmedicated birth?

Yes

Have you had a cesarean?

Yes

Have you had a VBAC?

Yes

Where are you planning to have your baby? *

Hospital

Birth Center

Home

Not Sure Yet!

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? *

Birth Boot Camp Comprehensive: 10-Week Complete Preparation for an Amazing Birth ($50 deposit required)

Hospital Birth Class ($30 deposit required)

Out-of-Hospital Birth Class ($30 deposit required)

Early Pregnancy Class: Food & Fitness ($25 deposit required)

Refresher Class ($25 deposit required)

Comfort Measures: Amazing Coping Strategies for Labor ($25 deposit required)

Newborn Care Class ($25 deposit required)

Sibling Class (must be paid in full before our class)

Private Class ($75 deposit required)

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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