Cesarean Birth Class and Birth Planning

Labor with Danielle

Cesarean Birth Class and Birth Planning Registration Form
1. This agreement is between Labor with Danielle and the client to provide education and classes for the client. Registration is for the pregnant individual and one support person, OR the pregnant individual and intended parent(s), or intended parent(s)/adoptive parent(s).

2. Client responsibilities:

a. Payment is due at the time of registration. If payment is not made

within 48 hours, registration will be canceled.

b. A refund will only be given if cancellation requests are made 48 hours before

the start date of the class. A $25 fee will be assessed for each cancellation.

c. No refund is given if the client doesn't show up or misses the scheduled class.

d. Labor with Danielle is happy to accommodate requests to reschedule at least 2

business days before the class date. However, we can not guarantee class

availability. A $25 fee will be assessed for each request to reschedule.

e. If you give birth before the class, you may request a full refund. Proof may be

requested and required before a full refund processed.

f. Birth classes are small, with a max of 4 couples.
I understand and accept the above*

YesNo
Name*

First NameLast Name
Partner's Name*

First NameLast Name
Expected Due Date*
Date of Scheduled Cesarean Birth

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you expecting a girl or boy?*
What services are you registering for?*
What's included:
- 1 hour in-person or virtual private birth planning consultation
- Access to a self-paced online program that provides education on your birth options
- Ability to create a graphic cesarean birth plan
- Tips to advocate for your birth options
- 1 hour in-person cesarean birth group class ( up to 4 couples)
- Preparing for cesarean birth handout
We recommend registering for this education and class between the 20th-36th weeks of your pregnancy.
Upcoming Birth Basics Class Dates

We currently do not have any scheduled classes on the calendar. Please inform us of your availability below and we will reach out to discuss possible class date options.Other
If you don't see a scheduled class date that works for you, let us know so we can see if other class options are a possibility. Do you have any specific needs or questions we can help you with?
Are you working with a doula?*
How did you hear about our cesarean birth planning and class?*
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Labor with Danielle