Enrolment Form - Mama Gaia Hypnobirthing
Thank you for your interest in Mama Gaia Hypnobirthing course. For me to cover all the information relevant to you and your birth partner (and make sure the snacks don't cause digestive upsets!) I just need a bit of information about you.

To confirm enrolment please deposit $200 ($100 for "Not My First Rodeo") to Meredith Gee 04-2024-0173984-00. The final payment of $260  (or $180) is due one week prior to commencement - I'll send a reminder email including all course details.
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Email *
First name *
Last name *
Which course do you want to attend?
Clear selection
Birth partner's name
Is your birth partner also your life partner (or friend or sister etc - if so let me know the connection)?
Clear selection
Phone number
Plans for where to birth?
Midwife's name
Expected due date
Apologies that you have to select an exact date but please know that I know that due dates aren't exact ;)
MM
/
DD
/
YYYY
Any dietary requirements?
Anything else you'd like me to know e.g. conception journey, anxieties or pregnancy complications 
How did you hear about this course?
Quality assurance *
Hypnobirthing Australia/HypnobubsⓇ may contact you for quality assurance and research purposes in the future. If you consent to be contacted, please note that you are free to change your mind at any time. Be assured that we will not share your personal identifying information with anyone outside Hypnobirthing Australia™ / Hypnobubs for any purpose. Thank you for your help in collecting data to support the growth of hypnobirthing. 

Do you agree to be contacted by Hypnobirthing Australia™/ Hypnobubs for research/quality assurance purposes?
Do you consent to having photographs taken of you during the course and shared on social media/my website? *
Enrolment agreement  *
I hereby state that I am enrolling in the session of my own free will and with the understanding that this is a program designed to teach me to use my own natural abilities to bring my mind and my body into a state of relaxation. I further understand that the content of these classes is in no way intended to be represented as medical advice, nor as a prescription for medical procedure. I am aware that I should seek the advice of a health- care provider to answer any health-related or pregnancy-related issues surrounding my pregnancy, my labour, or my birth.

I therefore agree that I will in no way hold the instructor of the hypnobirthing session/s, or Hypnobirthing Australia/Hypnobubs®, its owner, or its representatives responsible for any special circumstances that could arise as a result of my pregnancy, my labour, the birth of my child or recovery; and I agree that neither I nor my birth partner or any member of my family will make any claim or initiate any suit against any of the above-named parties now or at any time in the future.

In respect for privacy for the families who have allowed their private videos and photos to be included in the course content; I agree not to photograph, video, screen-capture, record, share or upload to the internet any of the content shared in these sessions.

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