Registration form - Happy Birthing

Registration

To register please fill the form here below:

Registration form

Mother's name *

First

Last

Home Address *

Post Code *

Telephone number *

In case I need to reach you urgently in regards to the course

Age

(I'll not share this info with anyone! I need it to better help you with NHS protocols)

Email *

Please enter your email, so I can follow up with you

Birth partner *

Who will be with you during the birth? Please indicate name and - if you wish - the relationship

Are you registering for a GROUP or a PRIVATE course? *

GROUP
PRIVATE (Refresher included)
COMBINATION of Group-Private (GROUP but I need to replace some of the group sessions with private classes)

Birthing facility *

e.g.: St. Mary's birth centre

When is the baby expected? *

Estimated due time

What worries do you have about birth? *

Please list the worries or doubts you have, without thinking too much... simply put them down. I'll be better able to help you. They'll remain confidential.

Where did you hear about my courses? *

Google search, HypnoBirthing directory, Facebook, referral from a friend, ...

Signature *

By typing your name here, you are signing this form electronically and agree to my Privacy Policy.

To complete the registration and book the place, please use the below bank details for the payment of the fee.

Bank: HSBC, Account number: 81501909, Sort code: 40-07-06.
(Please use your first name as the payment reference, or I may not recognise where the funds are coming from)

Registration

To complete the registration and book the place, please use the below bank details for the payment of the fee.

Thank you