KW Mother Nurture Hypnobirthing
Thank you for your interest in a hypnobirthing course with me. Please complete this form in full and read the terms and conditions at www.kwmothernurture.co.uk

Your information will be stored in accordance to the privacy policy available to read at www.kwmothernurture.co.uk
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Please select the course type you are interested in *
Full name (Birthing person) *
DOB (Birthing person) *
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Email address (Birthing person) *
Postal Address (Birthing person) *
Phone number (Birthing person) *
Baby's estimated due date *
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Birth Partner's Full Name (or emergency contact if no birth partner) *
Birth Partner/Emergency contact telephone number *
Birth Partner email address
What do you hope to get out of this course?
Aromatherapy/essential oils may be used during these sessions. Please indicate if you or your birth partner have any allergies or relevant conditions that could prevent the use of these oils. *
Any other information that you think I may need to know about you, your family or your pregnancy (medical or otherwise) *
Thank you for your information. Completion of this form does not guarantee you a space on the course. Your booking will be confirmed once a deposit has been received - we will be in touch shortly with payment details. By completing this form you agree to the terms and conditions available at www.kwmothernurture.co.uk.
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