Please fill out the Enrollment Form below. After you’ve completed the form you will be sent to the Payment page. All required items are marked with a * Mother's Name:* Mother's Occupation: Birth Companion’s Name (spouse, partner, etc):* Birth Companion's Occupation: Street Address:* City:* State:* Zip Code:* Preferred Cell Phone:* Alternate Cell Phone:* Mother's Email:* Birth Companion's Email* Mother's Age:* Name of Doula (if applicable): Birthing Facility: Practitioner Name & Title (i.e. OBGYN, Midwife):* When is baby expected?* How many weeks pregnant will you be when you begin classes?* I wish to enroll for class beginning (enter date):* Have you taken previous childbirth classes?* YESNO If yes, which one? How did you learn about Confident Birth?*