GentleBirth Registration Form

Workshop Registration Form

Pop some (um...non-alcoholic?) champagne! You're on your way to being a more calm, confident, and in control parent!
Name

PrefixFirst NameMiddle NameLast NameSuffix
E-mail*
example@example.com
Contact Number*

Area CodePhone Number
Is this number "textable?"

YesNo
Gender
Birth Date

MonthDayYear
Birth Partner/Support Person's Name (if applicable)

PrefixFirst NameMiddle NameLast NameSuffix
Contact Number*

Area CodePhone Number
Is this number "textable?"

YesNo
Intended Place of Birth
Is this your first birth?
Estimated Due Date
Workshop Format
Which workshop date are you registering for?

Let's set up a date/time frame that works for me!Lancaster, Dec 7-8, 2:00-7:30
Have you used GentleBirth materials in the past? Check all that apply:

No, this is the start to my more positive birth!I've taken a GentleBirth workshopRead "GentleBirth"Read "Mindful Pregnancy"Used the GentleBirth appOther
Why have you chosen GentleBirth to prepare for your birth?
Have you started your daily practice using the GentleBirth App?

YesNo, but I will be soon!
How did you hear about GentleBirth?
Do you have any special dietary requirements? (applicable for some in-person workshops)
Are there any special circumstances you'd like your instructor(s) to know about in confidence (i.e. medical condition, mental health concerns, previous birth or sexual trauma, etc)?
Anything else you'd like your instructor(s) to know before we dive into the workshop?

Payment*

USDPlease pay $250 for in-person workshop

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Workshop Registration Form