Course
Enrollment Form
Must be completed in advance

Mandatory Enrollment Form

Participant Agreement & Disclaimer

I acknowledge that I am enrolling in the HypnoBirthing® program voluntarily and understand that it is designed to teach relaxation techniques that support the natural abilities of my mind and body during pregnancy and birth. I understand that a pain-free birth cannot be guaranteed, as many factors may influence my labor and delivery.

I further understand that the information provided in these classes is not intended to replace medical advice, diagnosis, or treatment. I agree to consult with my physician, midwife, or other qualified healthcare provider regarding any medical or pregnancy-related concerns.

I agree that I will not hold the HypnoBirthing instructor(s), HypnoBirthing Las Vegas, or the HypnoBirthing Institute, its owners, or representatives liable for any complications or outcomes related to my pregnancy, labor, or delivery. I also agree that neither I nor any member of my family will pursue any claims or legal action against the above-named parties now or in the future.

I understand that all payments are non-refundable. If I do not complete the full class series, I will not be eligible for a refund.

For private sessions, I understand that scheduling accommodations are made for my convenience. I agree to provide a minimum of 4 hours’ notice for any rescheduling. Failure to do so may result in a $50 rescheduling fee. This fee may be waived in cases of true emergencies or active labor

Accept Enrollment Agreement

Preferred Class

5 Group Classes - $395

3 Private Sessions - $750

1 Day Intensive Class - $650

Preferred Group Class Start Date

2nd Choice Group Class Start Date

Private Session Preferred Days & Times

Expecting Mother Information

First name

Last name

Age

Expected Due Date

Current Weeks Pregnant

Order of Birth

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Mother's Occupation

Partner's Information

Name

Age

Partner's Occupation

Primary Birth Companion

Doula Information

Have you hired a doula

Doula's Name

Prenatal Care Information

Prenatal Care Provider

Prenatal Care Provider's Name

Care Provider Attending Birth

Birth Attendant's Name

Birth Location Information

Birthing at:

If birthing at a location other than home, please complete the following:

Birthing Facility

Other Information

Have you taken a previous childbirth class

If yes, what type of childbirth class:

Where did you first hear about HypnoBirthing:

Where did you first hear about HypnoBirthing Las Vegas:

If applicable, please list Referring Person/Source:

Course Enrollment Form *Must be completed in advance*

Mandatory Enrollment Form

Course
Enrollment Form
Must be completed in advance