Childbirth Education Course Registration

Childbirth Education Course Registration

2022 sessions
Full Name*

First NameLast Name
Due Date:
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail *
example@example.com
Healthcare Provider:
*A non-refundable deposit of, $300 will be due in full upon the signing of this contract. My fee reserves your place in my calendar for select class dates. In the event you are not able to attend a class, you will receive a coupon code for a make-up class. Each student has the ability to listen to up to two sessions with a coupon code, bringing the session price to $9.97. Fees are non-refundable and non-transferable.

By signing below, I acknowledge that my childbirth educator is not providing medical advice in this course and encourages all people to consult with their healthcare provider for medical guidance.
Client Signature

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