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 paypal.me/BabySTEPSbirth. The remainder amount will be requested on the first night of class. You may pay via PayPal, cash, check, or credit card.
Mom's Name
Your answer
Partner's Name
Your answer
Address
Your answer
Email
Your answer
Phone Number
Your answer
Mom's Age
Your answer
Estimated Due Date
MM
/
DD
/
YYYY
# of Children
Your answer
# of Medicated Births
Your answer
# of Non Medicated Births
Your answer
# of Cesareans
Your answer
# of VBACs
Your answer
Where are you planning on having your baby?
Who is your care provider?
How did you hear about Birth Boot Camp?
Your answer
How do you feel about taking childbirth classes?
Your answer
How does your partner feel about taking childbirth classes?
Your answer
Any concerns or fears about this pregnancy/birth?
Your answer
What I would like to learn in this class is...
Your answer
Please briefly describe your previous pregnancy/birthing experience(s), if applicable
Your answer
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