ENROLMENT FORM

Hypnobirthing Australia™ Course

The Course fee includes

· 12 hours of personalised training, two Australian practice Albums,
your comprehensive Hypnobirthing Australia™ folio of additional reading and resources,
plus ongoing support of your pregnancy and birth.

· Affirmation Cards for your practice

· Refreshments (Morning tea & Afternoon tea)*

· A complimentary gift bag, personally prepared for you to indulge your pregnancy and birth.*

*Subject to location and methods of course delivery

<To reserve your space in class please send the enrolment form below
with a $150 non-refundable tuition deposit.
Final payment is due 7 days prior to course start date.>

Fee : $530 Per Couple / Group Classes

Payment can be made by Paypal

Paypal Details:
Bitna@birthingbreeze.com.au

Enrolment Form

* Indicates required field

Hypnobithing Mother's Name *

First

Last

When is baby expected? *

Birthing Companion (Name of spouse, partner etc.) *

First

Last

Relationship *

Birthing Assistant (if applicable) *

Relationship (doula, friend, etc.) *

Email *

Preferred Phone Number *

Alternate Phone Number *

Mailing Address *

Suburb, State, Postcode *

Care Provider Name & Title (e.g. Obstetrician or Midwife) *

Intended place of birth (name of hospital or birth centre or home) *

How many weeks pregnant will you be when you begin classes? *

Is this your 1st, 2nd, 3rd etc baby? *

Is this birth a VBAC (Vaginal Birth After Caesarean) or is there any important information/medical conditions/psychological or psychiatric treatment you need me to be aware of before classes commence? *

I wish to enrol for the Hypnobirthing Course beginning (date) *

Location *

How did you hear about us? *

Submit

"To change the world, we must first change the way the babies are being born." - Michel Odent

Hypnobirthing Australia™ Course

Enrolment Form

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