Hospital Series Registration

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Birthing Person's name *

How do they about taking a childbirth class?

Birth Partner's Name *

How do they feel about taking a childbirth class?

Address

Email *

Phone Number *

Due Date *

YYYY

Which series are you registering for?

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

Who is your care provider?

What do you hope most to learn in our series?

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

Yes

Other:

I understand that I will not be considered registered for the Training for an Amazing Hospital Birth series in which I am registering for until I have paid my deposit of $50. I understand that this deposit is non refundable. I understand that the remainder of the balance is due during the first class, and is non refundable. I understand that if this is an issue I need to speak to Carol Meadows prior to the first class session and make arrangements. *

I understand

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

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