Class Registration Form

Registration Form

Fill out the form carefully for registration
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Class Selection*
*Select the class you are signing up for. Choose the correlating item from the product list at the bottom of the page.
Name of Partner or Birth Companion

First NameLast Name
Relationship to Birthing Person
Partner/Companion Email
example@example.com
Planned Birth Place

HospitalBirth center (out of hospital)HomeOther
Are you a Nesting Place client (either birth center or home)?

YesNoUncertain
Contact Delissa to learn about discounts for Nesting Place clients.

Text, Call, or Email:

(907) 420-4932

delissa.owen@gmail.com

Already have a code and know about discounts? Continue filling form and add your code!
First birth experience?

YesNo
Topics I’m most interested in learning about:*

Stages of LaborAnatomy/Physiology of birthPain-coping techniquesLabor positionsComfort MeasuresPartner supportInformed decision makingCommunication with support teamHospital procedures and technologyPostpartum healingMaking a postpartum planNewborn careBreastfeedingInfant feeding optionsOut of hospital birthHospital birthCare provider optionsOther birth worker support (birth/postpartum doulas, placenta encapsulators, photographers, etc)Optimal Fetal PositioningPain medication options and optimal timingWhat to expect in a cesarean birthVBACOther
How did you hear about this class?
Additional Comments or Questions
*Registration closes one week before the first class session.

*No refunds for cancellations less than one week before the first class.

*If the minimum number of sign ups is not met, the class will be cancelled. You will have the option to switch your registration to the next class or obtain a refund.

*An additional class may be added at the end of the series if I need to cancel a class due to being at a birth. No refund will be given for class being canceled and rescheduled in this way.

My Products*

Childbirth Class Series

Childbirth Class SeriesPrice covers you and your birth partner for the entire series

$250.00

Add-Ons

Motherboard Birth PlanningAdd to any class. Get year long access to an in-depth visual birth planning app. Create your birth plan and research all your options. Includes evidence-based research and information about your options and choices. Allows you to layout your plan in a concise way and share it with your entire birth team. $50 value.

$30.00

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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