Education is the Key to a Positive Birth Experience...
858.254.9515
Your Subtitle text

Enrollment Form

*IMPORTANT- If you fill out the enrollment form, but do not receive a confirmation email within 24 hours, email Care at Care@SanDiegoHypnoBirth.com
HypnoBirthing®--the Mongan Method

Care M. Messer- CHBE, CD(DONA)
Christal Quick - CHBE CD(DONA)
Ashley Stetson - CHBE, CD(DONA)
Debbe Cannone - CHBE, CD(DONA)
Britney Murillo - CHBE, CD(DONA)


www.SanDiegoHypnoBirthing.com

For questions call: 858.254.9515858.254.9515

Course Enrollment Information Form
Make sure you register and pay your deposit BEFORE filling out the enrollment form. Register here

Mother's Information
First Name:
Last Name:
Mailing Address:
City:
State:
Zip Code:  (5 digits)
Preferred Email:
Alternate Email:
Preferred Phone:
Alternate Phone:
Birth Companion & Birth Assistant Information
Birth Companion Name:
Birth Companion Relationship:  (spouse, partner, etc)
Birth Companion Phone:
Birth Companion Email:
Birth Assistant Name:
Birth Assistant Relationship:  ( Doula, Friend, Mom, etc)
Baby Information
Birthing Facility: (Hospital/Birth Center)
City:
When is baby expected?:
 First Baby?:  
How many weeks pregnant when class begins?  (ie 30 weeks)
Gender:
Class Information
Class to enroll in:
Property Information
Payment Type:  Make checks payable to "San Diego HypnoBirthing"

I paid in full online
I paid deposit online and will make both payments online
Deposit and 3 postdated check payments enclosed
Other 
Other Information
I Agree!

*IMPORTANT- If you fill out the enrollment form, but do not receive a confirmation email within 24 hours, email Care at Care@SanDiegoHypnoBirth.com

Tuition Fees: (fee includes textbook, audio practice download card, and handouts.)

Group Classes $375

Private Classes
$575

Makeup Classes
$100 each

I hereby state that I am enrolling in the HypnoBirthing class 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 labor, or my birth.

I therefore agree that I will in no way hold the instructors 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 labor, 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.

*IMPORTANT- If you fill out the enrollment form, but do not receive a confirmation email within 24 hours, email Care at Care@SanDiegoHypnoBirth.com

Mother's E-Signature:  Date:
Partner's E-Signature:  Date:  
Security Code: *  

Website Builder