Parent booking form

    Which course are you booking?(required)

    Your full name (required)

    Your email (required)

    Your contact number (required)

    Your address (required)

    Your birth partner's name (required)

    Your birth partner's email (required)

    Your birth partner's contact number (required)

    What is your due date? (required)

    How many weeks are you now? (required)

    Which hospital or other setting are you planning to have your baby/babies(required)?

    How many babies are you expecting? (required)

    Do you have a birth plan e.g. a date by which the doctors have advised an induction date or a planned c-section date? Tell me a bit about your feelings on how you wish your birth to happen and your feelings on this plan.

    Have you attended or planning to attend any other antenatal course? (required)

    Can I share your contact details with other members of the group? (required)

    How did you hear about the course? (required)

    If it can be arranged, would you like an additional talk on naming ceremonies/bris/or other religious ceremonies?

    If yes, which in particular?

    Are you interested in being emailed from time to time about my future courses eg postnatal workshops or those of selected partners of mine eg first aid courses? (required)

    I will keep the information below in confidence and only share it with the other relevant teachers if appropriate. The reason for asking is that it helps us to be as sensitive as possible to everyone’s needs.

    Is this your first pregnancy? (required)

    If no, please tell me a bit about your previous birth experiences and antenatal classes.
    In this pregnancy, have there been any complications so far?

    If yes, please tell me a bit about any complications.

    Did you undergo any fertility treatment?

    Do you have any other children?

    If yes, what are their ages?
    Does your birth partner have any other children?

    If yes, what are their ages?

    Please note, your place on this course will not be booked until full payment is received.