Enrolment Form Mother's Name * First Name Last Name Mailing Address * Full postal address (a workbook will be posted to you) Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number * (###) ### #### Email * Birthing Partner * First Name Last Name Relationship: * Spouse Partner Friend Mother Doula Lead Maternity Carer: * Name and Title (midwife, obstetrician) Hospital / Birthing Facility * Location for your birth When is baby expected? * Is this your 1st, 2nd, 3rd etc baby? Is this birth a VBAC? Is there any important information I need to be aware of before classes commence? Medical conditions, psychological or psychiatric treatment, special circumstances for you or baby? I wish to enroll for the course beginning (date)? * Please identify if this is in-person or zoom How did you hear about A Calm Space? * Friend/Family Healthcare clinician Alternative medical clinician Internet search/Website Social media Other Thank you! To hold your place for this class a non-refundable tuition deposit of $150 is required to be paid alongside this enrolment form. Click here now for deposit details.
