Basic Training Registration

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

Birthing Person *

How do they feel about taking a childbirth class?

Birth Partner's Name *

How do they feel about taking a childbirth class?

Address

Email *

Phone Number *

Estimated Due Date *

YYYY

Which series are you registering for? *

Are you or your partner allergic to any foods, or scents such as essential oils? *

How did you hear about me/Birth Boot Camp? *

Who is your care provider?

Is there anything in particular you are hoping to learn from this class?

I understand that I will not be considered registered for the Basic Training class until I have paid my deposit of $75. I understand that this deposit is non refundable. I understand that the remainder of the balance is due the day of the class and is non refundable. *

I understand.

Other:

Thanks for your interest! When Carol gets this form she will send you an email confirmation with class details and payment information.

Submit

Clear form

Never submit passwords through Google Forms.

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

Forms