Childbirth Class Registration Form
This form is to register for Valerie Rollo's available Birth Boot Camp Childbirth classes. Once you have registered, I will contact you via your preferred method of contact. A $50 deposit is due to reserve your spot in class with the remaining balance due the first day of class. Please use one of the links at the bottom of this form to submit payment; there are both Pay Pal and Venmo links. If you have any questions, please call or text 469-810-1370 or email me at valerierollo2021@gmail.com. I would love to chat with you!
Email *
Mom's name *
Partners name, if applicable *
Email *
Phone number *
Mailing address (Street, City, State, Zip. code) *
How do you prefer to be contacted? *
Required
Estimated due date *
MM
/
DD
/
YYYY
Which 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 class? *
Are there any special circumstances surrounding this pregnancy that you would like me to know?  *
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