Registration and Contract

Hypnobirthing Class

Location: Niavana Studio Holistic Healing Center

OR your (or a friends) home.

Cost- $350 for classes at Niavana
$450 for private classes.

Name

First Name

Last Name

Partner's Name

First Name

Last Name

Phone Number

Email Address

Place you are planning to birth

Estimated due date Or Date of Birth

MM

DD

YYYY

Check below

I understand that I will have to pay the full fee to guarantee my place.

Signature

Please Check below

I understand and agree to the above information; the preceding Responsibilities of Client; Payment, Cancellation, and Refund Policy; and Release of Liability. I authorize the release of my placenta to Wonder Women Birth. a

Name of consenting mother

Name of consenting birth partner