Petersfield February Group Hypnobirthing Course Enrolment Form

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Please complete the following form to register on your chosen course. A £50 non-refundable booking deposit will then be requested to secure your place. The rest of the fee is due one week before the course starts unless a payment plan has been agreed in advance (email me on hampshirebirthing@gmail.com to discuss your options). Payment is taken via bank transfer (BACS).

Estimated Due Date *

YYYY

First or Subsequent Birth *

First

Subsequent

Mother's First Name *

Mother's Last Name *

Mother's Age

Email *

Address *

Phone number *

Mother's Occupation *

Birth Partner's Name *

Birth Partner's Occupation *

Where did you hear about The Hampshire Birthing Company? *

Google Search

Other Internet Search

Facebook

Instagram

Personal Reccomendation

Other:

What do you hope to gain from Hypnobirthing?

Is there anything you'd like me to be aware of in advance (e.g. special circumstances in pregnancy, previous loss, trauma)?

By submitting this form I agree to the following terms and conditions listed at hampshirebirthing.com/terms-conditions: *

I agree

Required

I understand the course requires a minimum of four bookings to go ahead and that in the unlikely event this minimum is not met, my deposit will be refunded or can be used for an alternative course run by The Hampshire Birthing Company. *

I understand

Required

GDPR & Data Storage

I agree for my KGHypnobirthing Teacher (Susanna Dunnett) to hold my details on file and on computer in accordance with GDPR Guidelines May 2018.

I would like to receive future information from The Hampshire Birthing Company.

Submit

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