PPN Registration Form & Contract

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This form is for Pre and Perinatal Study Group participants.

To register for other classes or workshops visit these forms:
RiverBluff Sanctuary Class Registration
Birthing Yourself Process Workshop (long form) - for first time Birthing Yourself participants
Birthing Yourself Process Workshop (short form) - for PPN students and returning Birthing Yourself partipants

Facilitator

Janet Evergreen, MA
(434) 906-4181
janet@janetevergreen.com
www.janetevergreen.com

Two-year training by Zoom - 11 Modules:

PPN Year 1
Feb 15-June 20, 2024 - no class Apr 4
Sept 12-Dec 12, 2024 - no class Nov 28

PPN Year 2
Feb 6-June 19, 2025 - no class Apr 3
Sept 11-Dec 4, 2025 - no class Nov 27

Email *

Name *

Telephone Number *

Address *

Birthdate and Age *

Familial Status (i.e. married, partnered, single, divorced, children, grandchildren...) *

Occupation *

Emergency Contact: Person and Phone Number *

Communication Preferences

Yes, you can text me.

I am willing to share my phone and email with the group.

Other:

Required

Please Note

Many of the following questions are personal. Your response will be kept completely confidential. Please take the time to reflect on your intention at this time. Filling out this form actually begins your journey of Birthing Your Self.

Allow for your intention to clarify and change over time. When we meet we will ask again about your intention, as your learning will follow the felt sense of your words.

All information is completely confidential. If you are uncomfortable responding to any of these questions, email or telephone Janet or Tonya for support.

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