Participant Details

To be completed by both attendees if possible All information is strictly confidential

Use the form below to complete your registration details . If you run out of time you can save the form and return to it any time with in 30 days. Please note that the completion of this form does not guarantee you a place in your preferred course, payment must be received prior to your place being confirmed.

To be completed by both attendees if possible
All information is strictly confidential

Step 1 of 5

Personal Information
Mum's Details
Mum's Name*
Date of Birth*
Occupation*
Partners's / Class Companion's Details
Partner's / Class Companion's Name*
Date of Birth*
Occupation*
Other Personal Details
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Personal Email*
Mobile Number*

General Information
How did you hear about She Births®?
- Yoga
- Google
- Natural Therapist
- Friend
Referal Name

Provide their name if possible
Please describe your feelings about this approaching birth and parenthood*
What do you hope to gain from the She Births® course?*
Have you done any other childbirth preparation classes?*
Please describe your favourite place in nature*
What do you enjoy doing?*

Pregnancy Details
Estimated Due Date*
YYYY dash MM dash DD
Gestation at time of course*
Birth location*
delivery suite / birth centre / home
Caregiver's details and name
team midwifery / GP shared care / obstetrician / public / private / independent midwife
Doula's name
if applicable
Are your caregivers supportive of the She Births® classes?*

Preferred Course Dates
Private courses are taught over 2 x 3.5hrs. Held on Tuesdays, Wednesday or Thursday every fortnight. Times are 12-3.30pm or 4-7.30pm. Please let us know what you prefer and we will try to accommodate.
First Preferred Course Date
DD slash MM slash YYYY
Second Preferred Course Date
DD slash MM slash YYYY
Preferred Educator (If Available)
If your preferred educator is not available then we will help you find the best She Births to suit your needs
Registering for a She Births® Weekend Course requires you to read and agree with our She Births® Terms of Use
I have read the She Births® Terms of Use and agree to the She Births® Terms of Use*
- Yes
- No
Name
This field is for validation purposes and should be left unchanged.

We are blessed to live in this country. We offer our deep respect, acknowledgement and thanks to the traditional owners and elders past, present and future of this sacred land. We believe in climate justice and the decolonisation of birth. May we restore this planet together and restore birthing on country. May we all awaken to true healing and live in connection with country wherever we are on the planet.

We want to make preparing for birth as easy as possible. That is why we’ve partnered with Openpay.
You can now spread the cost of your online or Live Interactive Course over a 9 month period with interest-free payments.

Not ready to buy yet?

Sign up to our FREE Pregnancy Guide before you go and receive 10% OFF discount code for the Full Online Course

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Participant Details

To be completed by both attendees if possible All information is strictly confidential

Step 1 of 5

Personal Information

Mum's Details

Partners's / Class Companion's Details

Other Personal Details

General Information

Pregnancy Details

Health & History

MUM

PARTNER

Preferred Course Dates

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Not ready to buy yet?

Sign up to our FREE Pregnancy Guide before you go and receive 10% OFF discount code for the Full Online Course