Self Paced Childbirth Course Sign-up

Name *

First Name

Last Name

Phone *

(###)

###

####

Estimated Due Date *

MM

DD

YYYY

Partner/ Support Person's Name

First Name

Last Name

Class Agreements *

I/We fully understand and agree that this course is non-refundable except in rare and unforeseen circumstances (eg Loss of Pregnancy). I/We agree to and understand the class format (three remote classes and one in person class, with self paced materials). Due to the nature and information of this course, adult topics and information will be discussed. Children are welcome to attend if they are able to sit through the course and if their supervising adult feels comfortable with the subject material. I/We agree to and understand the content of this course is not to be shared without prior consent.

Consent to Class Agreements

Payment

Class total is $400. Payment via Venmo is preferred. You will be sent directly to my Venmo acct for payment after submitting this form. Check the box below if you need alternate payment method: