Mother Nurture Prenatal Class Intake
If you are filing this form out prior to contacting me, please email me ashley@mother-nurture.co to confirm there is space in the class before filing this intake out.

Congratulations on expecting your little one & thank you for your interest in my prenatal series. All information shared is kept confidential & is only used for me to cater the classes to the group of parents that will be attending. I look forward to meeting your family! 

This intake form is for the prenatal series starting June 4th 2024.

Dates 
530-830 PM @ Willow Midwives 587 Penticton Ave

Tuesday June 4th 

Tuesday June 11th 

Tuesday June 18th 

Tuesday June 25th 


RESCHEDULE DATES:

In the event I am called to a birth on the above dates classes will be rescheduled to the following Thursday. If this does not work for you please let me know and as a group we can play this by ear (add on an extra Tuesday at the end, weekend, etc) 
Sign in to Google to save your progress. Learn more
Email *
Contact & Payment Info
For any questions you can email me directly at ashley@mother-nurture.co  

The cost of the 6 week prenatal series is $300 per couple. 

A $150 non-refundable deposit is required to hold the space. 

The remaining $150 is due 2 weeks prior to your first class. An email reminder will be sent out. 

Cancellations: the $150 deposit is non refundable. Any missed classes will not be reimbursed. 

All E-Transfer's can be sent to ashley@mother-nurture.co 

If you would like to discuss a payment plan please contact me directly.  
Have you contacted Ashley to confirm there is availability for this series?

Email ashley@mother-nurture.co before completing this form please. 
 *
What is your name? *
What is your partners name? *
Phone Number(s) of those attending *
Will your partner be attending the classes? Or another support person? *
When is your estimated due date? *
Who is your care provider?  *
Where are you planning on birthing? *
Is this your first time giving birth? *
Do you have a doula? Will they be attending classes with you? *
What are you most interested in learning from this class? *
Is there any topics either you or your partner may find triggering?  *
Is there anything else you'd like to let me know? *
Where did you hear about this class from? *
How will you be paying your deposit? *
On our last day of class we will be putting together a birth vision board & birth preferences (birth plans). It can be helpful to start thinking about what you'd like to put on these boards. Your boards can be kept somewhere that you can reminder yourself daily that you are preparing for your little one, and can also be a powerful imagery tool to use during your birth. *These are optional, if you do not wish to create one please let me know* 

I provide: poster board or foam core (black/white), glue, scissors, craft paper & I do have a basket of images/magazines you are more than welcome to use from. 
You will need to bring: Any images you'd like to use, these can be online imagines, family pictures, it is whatever you want!
Please don't rely solely on the images I will have, an important part of the boards is making it personalized to your family & birthing wishes. 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Mother Nurture . Report Abuse
Google Forms