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Mother’s name
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Mailing Address
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Suburb
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State
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Postcode
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Preferred phone no
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Mobile/Alternate phone no
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Preferred email
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Birthing Companion
(Name of spouse, partner,
birthing partner)
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Relationship
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Birthing Assistant (if
applicable)
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Relationship (doula, friend
etc)
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Care Provider Name and Title
(eg Obstetrician)
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Location
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Hospital/ Birthing Facility
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Location
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When is baby expected?
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How many weeks pregnant will
you be when you begin classes?
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Is this your 1st, 2nd,
3rd, etc baby?
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Is this birth a VBAC or is
there any important information you wish me to be aware of before classes
commence?
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I wish to enrol for the 2015
Hypnobirthing Course
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4 consecutive Saturdays 9am-12am
or 4 consecutive Thursdays 7pm-10pm Morning tea or supper included
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Location
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8 Hakea Crt
Mt Helen, 3350, VIC. Ph: 0412715391
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Where did you hear about
Hypnobirthing Australia?
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Tuition fee: $495
Group Classes
Fee includes practice
CD’s (or MP3’s), and folio of resources
To reserve your place
in this class, please complete this form and return it with a $150
non-refundable tuition deposit. Final payment is due 7 days prior to course
start date
to: katrina@mindbodybirthing.com
Payment plan
available to clients with limited income.
Payment can be made
by cash or direct deposit
Direct Deposit
Details: Commonwealth Bank, K Foord, BSB 062692, Account number 24084698
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