Hypnobirthing with Helen ~ Booking Form
In order to secure your booking, please complete the form below. Full payment is required at the time of booking, unless agreed otherwise. Please read and agree to the terms and conditions by typing your name and today's date at the bottom of the form.
Sign in to Google to save your progress. Learn more
Email *
Mother's Full Name *
Age *
Occupation *
Address & Postcode *
Mobile Phone Number *
Email Address *
Do you have a Birth Partner? *
Required
What is your Birth Partner's relationship to you? *
What is your Birth Partner's Name? *
What is your Birth Partner's Phone Number? *
What is your Birth Partner's Occupation? *
Estimated Due Date *
MM
/
DD
/
YYYY
Is this your 1st/2nd/3rd+ baby? *
Required
Are you under any medical supervision for any health condition? *
Required
If you answered 'yes', please provide details
Where are you planning to give birth? *Please specify which hospital/birth centre/at home *
Where did you learn about BirthWright? *
What do you hope to gain from Hypnobirthing? *
Is there anything else you think I should know? (e.g. medication, allergies, etc.) *
Please make your selection from my Course Menu *
Please enter the full price of your chosen course *
Please enter the date(s) and time(s) of your course, as agreed with Helen *
Full Payment is required to confirm your booking. Please pay by bank transfer to the following Santander bank account: Miss Helen Elizabeth Wright, Sort Code: 09-01-28, Account Number: 97101650, using your name as reference for my records. I confirm that full payment has been made *
Required
Terms and Conditions for BirthWright 1)Booking: Full payment for your course to be made on reservation by bank transfer to the following account: Miss HE Wright, Sort Code: 09-01-28 Account Number: 97101650. Please use your name as a reference for my records. 2)Participant Cancellation: The fee will be repaid promptly and in full if your baby arrives before the course has been attended, less £50 to cover administrative costs. If the course has been partially attended and your baby arrives before the whole course has been attended, a partial refund will be calculated and issued accordingly, less £50 to cover administrative costs. In the very unlikely event of the course being cancelled, the fee will be repaid promptly and in full. These are the only circumstances under which a refund will be made. Exceptional circumstances will be considered on an individual basis with the utmost sensitivity. 3)Intellectual property: Any recording or written material included as part of this course and all rights worldwide (including Intellectual Property Rights) relating thereto respectively are the sole property of Katharine Graves, KG Hypnobirthing Ltd, Helen Wright, BirthWright, or others from whom such rights may be derived (whether or not protected by trademark and copyright laws) and may not be used other than for the personal use of the participant without obtaining prior written permission.The participant agrees not to record the course or any part thereof. 4)Data Protection: The participant agrees that Helen Wright, BirthWright shall hold your details on file and on computer and, in accordance with the Data Protection Act 1998, you are able to view your individual file by giving not less than seven days' written notice. 5)Disclaimer: Using Hypnobirthing techniques is not a substitute for the advice of, or the presence during birth or any part of pregnancy or labour, of a qualified medical practitioner, midwife or obstetrician. It does not represent in fact or otherwise an alternative to appropriate medical care or for professional medical advice in any way shape or form. Any questions or doubts that you have about the use of Hypnobirthing by you or any third party in any part should be discussed by you with your medical caregiver and the safety of, or the appropriateness of this programme to you or any third party whom you represent, be confirmed with your medical care giver prior to undertaking the programme. Helen Wright, BirthWright, its instructors or its representatives accept no responsibility for the inappropriate use of Hypnobirthing techniques or complications or harm to any third party resulting from the use of Hypnobirthing techniques as a substitute for medical advice. Hypnobirthing is intended solely as an aid to help increase the comfort of labour and birth and is not in any way a guarantee or promise of expected, imagined or actual outcome of the labour or birth in any way shape or form. Participation in Hypnobirthing classes in any part or in total by any person or third party is undertaken with the understanding by any persons or third party that no litigation or legal action whatsoever will be initiated or that no form of compensation or reimbursement or refund will be claimed or applied for at any time now or in the future against Helen Wright, BirthWright, its instructors, or its representatives under any circumstances whatsoever. 6)Agreement: Any booking of a Hypnobirthing class assumes full and informed compliance to and agreement with all of these terms and conditions of sale. In the event of a dispute, English law pertains. *
Required
Please enter your name and today's date to confirm. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of BirthWright. Report Abuse
Google Forms