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HypnoBirthing--the Mongan Method
Debbie Catz, M.S.W., C.Ht. H.B.C.E.
4535 W. Bobbie Terrace
Glendale, AZ 85306
602-674-0940


Course Enrollment



Mother's Name

Mailing Address

Preferred Phone

Alternate Phone

Preferred Email

Permanent Email

Birthing Companion

Relationship

Birthing Assistant

Relationship

Care Provider

City

Birthing Facility

City

When is baby expected?

How many week pregnant will you be when you begin class?

I wish to enroll for the HypnoBirthing class beginning(date)

Location

Tuition fee: (Group classes: $350.00; Private classes:$425.00 in my office; $500.00 your home (within 25 miles of Glendale, AZ))
(Fee includes 12-14 hours of instruction, textbook, audio practice CD, and handouts.) Discount available for clients with limited income.

HypnoBirthing Course Enrollment Agreement

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 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 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.

The HypnoBirthing® Institute uses online course evaluations and birth report surveys. May we send these to you in the future? Please note that you are free to change your mind at any time. Be assured that we will not share your personal identifying information with anyone outside the HypnoBirthing® Institute for any purpose. Thank you for your help in collecting data to support the growth of HypnoBirthing®.

I do I do not agree to receive online surveys from the HypnoBirthing® Institute.


Mother’s Signature

Date
Online
Enrollent/Agreement Form
Online
Financial Form