Pregnant Student Class Enrollment Form

Pregnant Student Class Enrollment Form

Pregnant Student only, fill out, sign and date please
Instructor and Class Date Information:
HYPNOBABIES INSTRUCTOR'S FULL NAME (NOT *your* name!)*

First NameLast Name
Hypnobabies Instructor’s EMAIL ADDRESS:*
example@example.com
Hypnobabies Instructor's Phone Number*
Please enter a valid phone number.
Hypnobabies Class Start Date:*

MonthDayYear
Date
Will you be attending a 1) Group Hypnobabies Class Series or 2) Private Hypnobabies Class Series or 3) Home Study Advantage Class (only for Hypnobabies Self-Study students)?*
Pregnant Student & Birth Partner Information:
PREGNANT STUDENT'S FULL NAME:*

First NameLast Name
Pregnant Student's Email Address:*
example@example.com
Pregnant Student’s Mobile #:*
Please enter a valid phone number.
Pregnant Student's Mailing Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Estimated Due Date:*

MonthDayYear
Date
This is my first baby*

YesNo
Did you have a phone conversation with your Hypnobabies Instructor?*

YesNo
YOUR BIRTH PARTNER'S FULL NAME:*

First NameLast Name
Birth Partner's Email Address:*
example@example.com
Birth Partner’s Mobile #:*
Please enter a valid phone number.
I am/we are planning a:*

Home BirthHospital BirthBirth Center BirthOther
I am planning a VBAC! 💕*

YESNO, not applicable
Planned Birth Location*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Any concerns or fears about this pregnancy/birth?*
What I would like to learn in this course is:*
Would you feel comfortable sharing your previous birthing experience(s), if applicable?
🤩 Please make sure your Birth Partner completes their own Hypnobabies Class Enrollment Form so you can receive your Pre-Class Hypnosis Tracks! https://form.jotform.com/240747886952170*

Yes, I willAlready completed!No birth partner
Hypnobabies Hypnobirthing Class Enrollment Agreement:
By signing below I, {pregnantStudents11}, declare that I have read ALL of the information on the Hypnobabies Class Enrollment Information page at Hypnobabies Class Enrollment Info and I understand and agree with all of the information on that page, before enrolling in this Hypnobabies Hypnobirthing class.
Name of Pregnant Student*

First NameLast Name
Pregnant Student Signature*

Clear
Date of Signature*

MonthDayYear
Date
Should be Empty:

Pregnant Student Class Enrollment Form

Instructor and Class Date Information:

Pregnant Student & Birth Partner Information:

Hypnobabies Hypnobirthing Class Enrollment Agreement: