Hypnobirthing Australia™ Course Registration
This form is for PRIVATE COURSE OPTIONS. If you are looking to book a GROUP course, please click here.

Christa Buckland
BHlthSc (Health Promotion), MPhil

If you have any questions please feel free to contact me via phone or email.


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Email *
Full name (mother) *
Mailing address *
Preferred phone *
Estimated Due Date *
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/
DD
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I wish to enrol in a: *
Please state the date(s) booked for your private  session(s). If we have not yet booked the dates, please state your availability/preferred times: *
Birth companion name *
Relationship to you (e.g. spouse, partner, doula etc.)
Intended place of birth (name of hospital, birth centre or home)
Care Provider Name and Title (e.g. Obstetrician or Midwife)
Is this your 1st, 2nd, 3rd etc. baby?
 *
Is this birth a VBAC (Vaginal Birth After Caesarean)?
 *
In order to ensure that I can provide a safe and comfortable environment for all please let me know if you have any dietary requirements, allergies or other needs.
Is there any important information you wish me to be aware of before classes commence?
How did you find out about my classes?
REFUND POLICY
For group classes:
A minimum payment of $150 is required to secure your booking and is non-refundable. The balance remaining ($345) must be paid a minimum of 7 days prior to the course start date. Cancellations/refunds cannot be accepted within 7 days of the course start date.  At this time, refund (of the $345 balance) can only be given in exceptional circumstances.

For private sessions:
A minimum payment of $150 is required to secure your booking and is non-refundable. The balance remaining must be paid a minimum of 14 days prior to the course start date. Please note refunds cannot be given for change of mind or change of circumstances once you have commenced your sessions and received your materials. I will be as flexible as I can with changing dates to suit your schedule however there is no refund if you have the baby prior to us completing our sessions. Course fees are not transferrable to any other service.
Please check the box below to acknowledge that you have read and understand the refund policy above. *
Required
SUBMIT YOUR REGISTRATION
Please submit this form (Step 1) and then attend to payment (Step 2) to confirm your booking. You will have the option to pay in full or pay a deposit to hold your spot. The payment links and information will be on the following page. Payment options include credit/debit card (PayPal/Stripe) and direct deposit (EFT). 

You will receive a copy of this form via an email from GoogleForms - please check your junk folder. IF YOU DO NOT RECEIVE AN EMAIL, THE FORM HAS NOT COME THROUGH. Please contact me if you have any issues submitting this form.

Thank you! Please click the submit button below to view the payment links. :)
A copy of your responses will be emailed to the address you provided.
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