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HypnoBirthing®--the Mongan Method

Maggie Horn . Yoly Leal Castellanos

Course Enrollment

 

Mother’s Name______________________________________________________________________________________________________

Mailing Address                                                           

______________________________________________________

City, State, Zip

______________________________________________________

 Preferred phone

______________________________________________________

Alternate phone

______________________________________________________

Preferred email

______________________________________________________

Permanent Email

______________________________________________________

 Birthing Companion (spouse, partner, etc.)                                     

______________________________________________________

Relationship

______________________________________________________

Birthing  Assistant                                                    

______________________________________________________

Relationship (doula, friend, etc.)

______________________________________________________

Care Provider Name & Title

______________________________________________________

City

Birthing Facility

City

When is baby expected?____________________________________________

How many weeks pregnant will you be when you begin classes?

 

I wish to enroll for the HypnoBirthing® class beginning (date):

 

 

 
 Tuition fee: $335 for Group and starting at $675 for Private Course

(Fee includes textbook, audio practice CD, and handouts.)

Balance to be paid in full on first class 
Please send this form with a $50.00 non refundable tuition deposit.
 

For classes with Maggie Horn make check payable to:

Maggie Horn and mail to

7770 SW 106 Terrace
Miami, FL 33156

For classes with Yoly Leal Castellanos make check payable to:

Yoly Leal Castellanos and mail to

4301 SW 136 Place

Miami, FL  33175

 

 

 




 

Text Box: Course Enrollment Agreement
 

                        

 

    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