Calm Birthing with Hypnobirthing Enrollment Form

Calm Birthing with Hypnobirthing Enrollment (Private course)

Location: 6 Coleraine Drive, Rototuna, Hamilton

Tuition fee: $400

Mother Name

Occupation

Your date of birth

Phone Number

Alternate Phone

Name of your birthing Companion

Relationship ( spouse, partner, etc.)

Midwife/ Care Provider Name & Title

Birthing Facility

Address

City

When is baby expected?

How many weeks pregnant will you be when you begin classes?

Do you have any other children?

yes no

How many?

I wish to enroll for the Calm Birthing private course on this date

(fee includes 4 hrs private tuition, a comprehensive manual, several MP3 audio recordings to assist with your practice at home.)

Please include your name with deposit so that I can identify your payment