Group Course

Mother's information

NameAge

Partner's information (if applicable)

NameAge

Email

Phone Number

Please enter a valid phone number.

Month of course

Estimated Birth date

First or Subsequent Birth?

Do you have any particular worries or fears about your birth?

Please both answer from your own perspective

What do you hope to gain from your Blossom Birth Empowerment course?

Please both answer from your own perspective

Is there anything else you wish to add, or anything you feel I should know? (Please note, you can call and discuss if you prefer!)

Do you have any allergies or dietary requirements? (Treats will be provided!)

How did you hear about Blossom Birth Empowerment?

Terms and Conditions
Payment
To be made on reservation, or by agreement in instalments. Payment must be made in full before commencement of your course.

Participant Cancellation
The fee will be repaid promptly and in full if your baby arrives before the course or in the very unlikely event of the course being cancelled. These are the only circumstances under which a refund will be made.

Data Protection
The participant also agrees that Blossom Birth Empowerment shall hold your details on file and on computer and, in accordance with the Data Protection Act 1998, you are able to view your individual file by giving not less than seven days' written notice.

Disclaimer
This course provides helpful information on pregnancy and birth. It does not constitute medical advice or an alternative to appropriate medical care, nor is it in any way a garuntee or promise of expected, imagined or actual outcome of labour or birth. It is not a substitute for the advice or the presence during birth or any part of pregnancy or labour of a qualified medical practitioner, midwife or obstetrician. Neither Blossom Birth Empowerment or KGH Ltd can accept responsibility for any liability or damage caused by or as a result of practising the techniques.

Agreement

Any booking assumes full and informed compliance to and agreement with all of these terms and conditions of sale. In the event of a dispute, English law pertains.

By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Date of Signature

Signature

Payment
The fee of £185 can be made by direct bank transfer to:

E Cotton
Account number 61644205
Sort Code 60-83-71

A non-refundable deposit of £50 will secure your place on your chosen course. Receipts will be sent as payments are made.

Thank you!

I look forward to meeting you at our course!
If you have any questions please contact me at:
07715876636

blossom.birthempowerment@gmail.com