Born Free Birthing - HypnoBirthing Course Enrollment Form

Name Name First Last
Birthing Partner (spouse, partner etc.) Birthing Partner (spouse, partner etc.) First Last
Home Address Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Phone of Birthing Partner Phone of Birthing Partner - ### - ### ####
Email
Estimated Due Date Estimated Due Date / MM / DD YYYY
Care Provider Name Care Provider Name First Last
Birthing Assistant/Doula Name Birthing Assistant/Doula Name First Last
Birthing Facility Name and Address
I wish to enroll for:
Private Class, $595.
Group Class $350.

Online classes via Zoom will take place from the comfort of your own home. All class times are CST.

One HypnoBirthing® course consists of five classes over a five week period. Each class is roughly 2 1/2 hours in length.

I wish to enroll for:
Private Class, $595.
Group Class $350.

Online classes via Zoom will take place from the comfort of your own home. All class times are CST.

One HypnoBirthing® course consists of five classes over a five week period. Each class is roughly 2 1/2 hours in length. Online Private HypnoBirthing Class - $595 Online Group HypnoBirthing Class - $350
I wish to enroll for class beginning (date):

*Monday's January 2nd - 29th, 6pm-8.30pm (Please note our start date is a Tuesday, the remainder of the series will be on Monday's)

*Monday's March 4th - April 1st, 6pm-8.30pm

*Monday's April 22nd - May 20th, 6pm-8.30pm I wish to enroll for class beginning (date):

*Monday's January 2nd - 29th, 6pm-8.30pm (Please note our start date is a Tuesday, the remainder of the series will be on Monday's)

*Monday's March 4th - April 1st, 6pm-8.30pm

*Monday's April 22nd - May 20th, 6pm-8.30pm / MM / DD YYYY
How many weeks pregnant will you be when you begin your classes?
Please note, a $75 non-refundable deposit is due via PayPal upon submission of this form. Cash and Check payments are also accepted. The remaining balance is due 24 hours prior to the first class.

Please note, a $75 non-refundable deposit is due via PayPal upon submission of this form. Cash and Check payments are also accepted. The remaining balance is due 24 hours prior to the first class. I understand
We love to know how you found us, and if it was a person we would love to know who to thank for the wonderful referral.

We love to know how you found us, and if it was a person we would love to know who to thank for the wonderful referral. Facebook Instagram Google OBGYN/Midwife/Care Provider The Official HypnoBirthing Website The Houston HypnoBirthing Website Birth/Baby Fair Free Information Session Born Free Birthing Website Media: TV, Blogs, Radio, Newspaper Other/Personal Referral Other/Personal Referral