Birth Boot Camp Class Registration

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Once completed, I will be in touch to confirm and collect your registration fee! Thanks!

Email *

Name *

Partner's name *

What is your address? *

What is a phone number where you can best be reached? *

How did you hear about my classes? *

Which class would you like to register for? *

Training for an Amazing Hospital Birth

Reboot Refresher

Siblings at Birth

Homecoming: Life with a New Recruit

Training for an Amazing Out-of-Hospital Birth

Comfort Measures

10 week Comprehensive Series

Basic Training: One Day Childbirth Prep Class

Prenatal Freezer Meal Workshop

Where do you plan to birth your baby? *

Who is your provider? *

What is your estimated due date? *

YYYY

How do you feel about taking childbirth classes? *

How does your partner feel about taking childbirth classes? *

In what ways have you prepared for childbirth during this pregnancy? (Books, movies, groups, etc) *

If you are comfortable sharing, was there any trauma in your past that could effect your labor and/or birth?

Do you have any questions for me or anything you'd like me to know?

I understand that I will not be considered registered for the above selected class in which I am registering for until I have paid the listed deposit fee outlined in the class description. I understand that this fee is nonrefundable. I understand that the remaining balance of the class is due at the first class and is also nonrefundable. I understand if this is an issue, I need to speak with Kelly Lipscomb prior to the first class session and make arrangements. *

I understand

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