Birth Boot Camp Class Registration
Please fill this out and send your $50 deposit before class starts. You can send your payment via Paypal at
. The remainder amount will be requested on the first night of class. You may pay via PayPal, cash, check, or credit card.
Estimated Due Date
# of Children
# of Medicated Births
# of Non Medicated Births
# of Cesareans
# of VBACs
Where are you planning on having your baby?
Who is your care provider?
How did you hear about Birth Boot Camp?
How do you feel about taking childbirth classes?
How does your partner feel about taking childbirth classes?
Any concerns or fears about this pregnancy/birth?
What I would like to learn in this class is...
Please briefly describe your previous pregnancy/birthing experience(s), if applicable
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