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!
* Required
Hi there! I'm so excited to meet you. What's your name?
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Your answer
What's your partner's name?
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Your answer
Email
*
Your answer
Address
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Your answer
Phone Number
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Your answer
How can I best contact you?
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Phone Call
Email
Text Message
Other:
Required
How old are you?
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under 18
18-29
30-39
40-49
Congratulations on your pregnancy! When is your estimated due date?
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MM
/
DD
/
YYYY
How many kids do you have?
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Choose
This is our first!
1
2
3
4+
Have you had a medicated birth?
Yes
No
Clear selection
Have you had a unmedicated birth?
Yes
No
Clear selection
Have you had a cesarean?
Yes
No
Clear selection
Have you had a VBAC?
Yes
No
Clear selection
Where are you planning to have your baby?
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Hospital
Birth Center
Home
Not Sure Yet!
Who is your care provider?
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Your answer
How do you feel about taking a childbirth class?
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Your answer
How does your partner feel about taking a childbirth class?
*
Your answer
Which class(es) would you like to register for?
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Birth Boot Camp Comprehensive: 10-Week Complete Preparation for an Amazing Birth ($50 deposit required)
Out-of-Hospital Birth Class ($50 deposit required)
Basic Training ($50 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)
Required
Coupon Code?
Your answer
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?
Choose
Google/Web Search
Referred by family/friend
Referred by provider
Referred by My Family Birth Center
Facebook
Business Card
Birth Boot Camp website
Another doula referred me
Doulamatch.net
Utah Doula Association
Utah Birth Forum
Referred by someone personally? Who can I thank?!
Your answer
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