Childbirth Class Registration Form
This form is to register for Melanie Galloway's available Birth Boot Camp childbirth classes. Once you have registered, I will contact you. In-person classes require a $50 non-refundable deposit and is due at registration to reserve your spot in class. Online Virtual class fees are due at registration. Please use the Paypal link at the bottom of this form. If you have any questions, please email me at melanie@gallowaymassageandbirth.com or text at 512-590-0404. I would love to chat with you!
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Name
Your Partner's Name
Address
Email
Phone Number
How would you prefer to be contacted?
What is your estimated due date?
MM
/
DD
/
YYYY
Which birth class would you like to register for?
Where do you plan to deliver your baby?
How many previous births have you had?
How did you hear about my birth classes?
Are there any special circumstances surrounding this pregnancy that you would like me to know?
During labor and birth, emotions associated with prior trauma (such as physical, emotional, or sexual abuse, reproductive trauma, pregnancy loss, etc) can come to the surface. As your support, it may be helpful for me to be aware of this history and what your triggers are or may be. As with all of your information, any information you share will be kept confidential.
To pay your $50 deposit or full class fee now, go to:
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