For a positive change to your life

 

 

 

 

Course Enrolment Form

 Mother's name:

 

 

 Address

 

 

 Home telephone

 

 Mobile/Work Phone

 

 Email address

 

 

 Birthing Companion Name:

 

 

 Relationship: (Spouse, partner, etc)

 

 

 When is baby expected ?

 

 Planned place of birth:

 

 Name of Community Midwife:

 

 Which hospital are you booked to have care with:

 

 I wish to enrol for the HypnoBirthing® class beginning

 

 

 

Please complete this form in full and send with a £50 deposit made payable to P Cowan at

Philippa Cowan, 34 Kingsley Walk, Ely, Cambridgeshire, CB6 3BZ

Email- philippa.cowan@btinternet.com with any further enquiries.

The remaining balance is payable in instalments with half paid at class 2 and the final balance at class 4.