Print this form, fill and mail to register. Back to Course & Tuition
HypnoBirthing®--the Mongan Method
Maggie Horn . Yoly Leal Castellanos
Course Enrollment
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Mother’s Name______________________________________________________________________________________________________ |
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Mailing Address ______________________________________________________ |
City, State, Zip ______________________________________________________ |
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Preferred phone ______________________________________________________ |
Alternate phone ______________________________________________________ |
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Preferred email ______________________________________________________ |
Permanent Email ______________________________________________________ |
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Birthing Companion (spouse, partner, etc.) ______________________________________________________ |
Relationship ______________________________________________________ |
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Birthing Assistant ______________________________________________________ |
Relationship (doula, friend, etc.) ______________________________________________________ |
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Care Provider Name & Title ______________________________________________________ |
City |
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Birthing Facility |
City
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When is baby expected?____________________________________________ |
How many weeks pregnant will you be when you begin classes? |
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I wish to enroll for the HypnoBirthing® class beginning (date): |
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Tuition
fee: $335 for Group and starting at $675 for Private Course
(Fee includes textbook, audio practice CD, and handouts.)
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For classes with Maggie Horn make check payable to: Maggie Horn and mail to
7770 SW 106 Terrace |
For classes with Yoly Leal Castellanos make check payable to: Yoly Leal Castellanos and mail to 4301 SW 136 Place Miami, FL 33175 |
I hereby state that I am enrolling in the HypnoBirthingÒ 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 HypnoBirthingÒ 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.
Mother’s Signature Date