Cultivate: The Birth Academy
Complete this form to register for the 6-week childbirth course at Rooted Birth Midwifery & Wellness. This course is held every Wednesday evening at the Rooted Birth office, from 6pm-8pm, starting September 16, 2026. Because it is offered in a continuous cycle, you can join anytime! Simply indicate which Wednesday you'll be starting the course. Each couple will receive a punch-card to keep track of the classes you attend. When you've finished all 6, you'll receive a gift from us.
Which week do you plan to start?
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Full Name
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First Name
Last Name
Spouse/Partner Name
*
First Name
Last Name
Relationship Status
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Married
Common Law / Partnered
Separated
Divorced
Other
None
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
E-mail
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Due Date
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Baby's Gender
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Boy
Girl
Surprise
Where are you planning to give birth?
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Who is your care provider for this birth?
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Who referred you to Cultivate?
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Additional Comments or Requests
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Cultivate: The Birth Academy
$300.00
$
300.00
This option gives you access to all 6 sessions of Cultivate: The Birth Academy, in any order you choose to attend. You'll be able to make up classes at any time as they are offered on a continuous basis, with each session available every 6 weeks.
Total
$0.00
$
0.00
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