Private Hypnobirthing Course Enrolment Form

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Please complete the following form to register your private course. I will then be in touch to discuss convenient dates. A £50 non-refundable booking deposit is required to secure your booking. The rest of the fee is due one week before the course starts unless a payment plan has been agreed in advance (email me on hampshirebirthing@gmail.com to discuss your options) . Payment is taken via bank transfer (BACS).

Mother's Name *

Would you like to book a Face-to-Face or Online course? *

Estimated Due Date *

YYYY

First or Subsequent Birth *

First

Subsequent

Mother's Age

Email *

Address *

Phone number *

Mother's Occupation *

Birth Partner's Name *

Birth Partner's Occupation *

Birth Partner's Email *

Birth Partner's Phone number *

Where did you hear about The Hampshire Birthing Company? *

Google Search

Other Internet Search

Facebook

Instagram

Personal Reccomendation

Other:

What do you hope to gain from Hypnobirthing?

Is there anything you'd like me to be aware of in advance (e.g. special circumstances in pregnancy, previous loss, trauma)?

By submitting this form I agree to the following terms and conditions listed at hampshirebirthing.com/terms-conditions: *

I agree

Required

GDPR & Data Storage

I agree for my KGHypnobirthing Teacher (Susanna Dunnett) to hold my details on file and on computer in accordance with GDPR Guidelines May 2018.

I would like to receive future information from The Hampshire Birthing Company.

Submit

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