Joymamma HypnoBirthing Enrolment

Enrolment for HypnoBirthing

* Indicates required field

Mother's Name *

First

Last

Mother's Phone Number *

Email *

Occupation *

Partner's Name *

First

Last

Partner's Phone Number *

Partner's Occupation *

Address *

Suburb *

State *

Post Code *

Estimated Due Date *

Name of Additional Birthing Companion *

First

Last

Relationship (doula, friend, etc.) *

Care Provider's Name *

First

Last

Care Provider's Title *

Birthing Facility *

ANY PREVIOUS PREGNANCIES? *

YES NO

ANY PREVIOUS BIRTHS? *

YES NO

If yes, are there any important details I should know about? *

How did you hear about Joymamma? *

COURSE ENROLMENT AGREEMENT *

I hereby state that I am enroling in the HypnoBirthing classes with Carrie Jeff of my own free will and with the understanding that this is a program designed to teach me to use my own natural abilities to bring my mind and my body into a state of relaxation. I further understand that the content of these classes is in no way intended to be represented as medical advice nor as a prescription for medical procedure. I am aware that I should seek the advice of a health‐care provider to answer any health‐related or pregnancy‐related issues surrounding my pregnancy, my labour, or my birth. I give permission to my HypnoBirthing Practitioner to use my email address for direct contact and understand that my email address will not be used in any other way. I therefore agree that I will in no way hold the instructor of the HypnoBirthing classes, or the HypnoBirthing Institute, its owner, or its representatives responsible for any special circumstances that could arise as a result of my pregnancy, my labour, or the birth of my child; and I agree that neither I nor any member of my family will make any claim or initiate any suit against any of the above‐named parties now or at any time in the future. In the event of me being unable to attend a scheduled class; I understand that I can make up the session at a mutually convenient time with myself and my HypnoBirthing Practitioner.

Birthing Mother's Name *

Date *

Submit

​hypnobirthing ​enrolment

Enrolment for HypnoBirthing

hypnobirthing enrolment