HypnoBirthing Class Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please submit your answers to the following questions along with a deposit to secure your place in an upcoming class.

Email *

First and last name *

Mailing address for class materials *

Estimated due date *

YYYY

Date of first class (please see the class schedule for start dates of upcoming classes) *

YYYY

Which kind of class? *

Group (standard)

Private (one-on-one with customizable dates)

Which investment method are you selecting? *

$375 Group - $75 deposit due upon enrollment with the remaining $300 balance due 7 days before the first class (Comfortably affords transport, housing, food).

I would like to know whether I qualify for sliding scale/payment plan or I have already been invited to join at a sliding scale rate or use a payment plan.

$525 Private - total due upon enrollment.

A nonrefundable deposit along with this form secures your place in the class. Once you have filled out this form and paid your deposit, I will follow up with an email within 24 hours confirming your enrollment in the class series. If you are enrolling less than 7 days before the class you can pay the full $375 in one installment.

I understand and I would like a PayPal invoice emailed to me.

I understand and I will pay via Venmo (@Sonja-Bjelic) or Zelle (shbjelic@gmail.com).

Required

Will this be your first birth?

Yes

Clear selection

Will a partner, doula, family member, or friend attend class with you?

Yes

Clear selection

Name of partner, doula, family member, or friend

Is there anything that you would like me to know about you before our class starts?

I hereby state that I am enrolling in the HypnoBirthing class of my own free will and with the understanding that this is a program designed to teach me to use my own natural abilities to bring my mind and my body into a state of relaxation. I further understand that the content of these classes is in no way intended to be represented as medical advice nor as a prescription for medical procedure. I am aware that I should seek the advice of a health-care provider to answer any health-related or pregnancy related issues surrounding my pregnancy, my labor, or my birth. I therefore agree that I will in no way hold the instructor of the HypnoBirthing classes, or the HypnoBirthing Institute, its owner, or its representatives responsible for any special circumstances that could arise as a result of my pregnancy, my labor, or the birth of my child; and I agree that neither myself nor any member of my family will make any claim or initiate any suit against any of the above-named parties now or at any time in the future. I also understand that the instructor is free to cancel the course if not enough attendees enroll or pay their balance and will return 100% of your investment 5 days before the start of class. By signing your name below you agree to the above terms and conditions. *

Today's date *

YYYY

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms