Class Registration

Deposit ($75.00)
Pay a $75 deposit to hold your space; the $190 balance is due on December 22nd and will be charged to your card on file.

If your card is declined for any reason when the balance is charged, there will be an additional fee of $25. If your card is lost, stolen, expired or otherwise it is your responsibility to notify me via the Contact Me page on the Birth Louisville website at least 24 hours before payment is due so that we can make alternate payment arrangements to avoid the fee. Thank you.
Pay in Full ($265.00)

Personal Information

Mother's Name

Occupation

Birth Partner's Name

Occupation

Primary Email Address

Primary Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Address

OB or Midwife's Name

Name of Hospital

Due Date

How did you hear about this class?

Is this your first labor & birth? Please feel free to provide details you'd like to share about past birth experience(s).

What do you hope to learn about in this class?

Terms & Policies

It is necessary for me to have a cancellation policy because my classes & workshops are usually at capacity, and potential students are turned away. If you (registrant/birth partner) are unable to attend the class, you must notify me in writing two weeks before the class start date to receive a refund or to transfer to a different class series. If you register with less than two weeks to go before the class start date, there are no refunds.

In the event of a public health crisis/emergency, I reserve the right to make changes to the class structure in accordance with regulatory guidance from the CDC and other organizations. Changes may include but are not limited to social distancing, online classes or masking. Should you (registrant) or birth partner object to/refuse to participate in these changes, attendance will not be allowed and refunds will not be given.

If you have paid a deposit and your card on file is declined for any reason when charged for the class balance, an additional $25 fee will be assessed.

Your signature confirms your agreement with these policies.

I, the undersigned, agree to the terms above.

Total

$0.00

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

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