About Us – Doulaing Sisters: Cleveland Doulas, HypnoBirthing Instructors

When would you like to begin the course?

beginning April 26 (in-person in Lyndhurst)

Do you prefer an in-person class meeting in Lyndhurst or a virtual class? We will try our best to accommodate.

In-person in Lyndhurst

Virtual

Both are fine

First Name

Last Name

Mailing Address

City

State/Province

Zip/Postal

Preferred Contact Phone Number

Alternate Phone Number

Email Address *

Date of Birth

Birthing Companion Name

Relationship

Birthing Assistant Name

Relationship (doula, friend, etc.)

Care Provider Name & Title

City

Birthing Facility

City

Have you birthed before?

Yes

No

What number baby is this?

Estimated Due Date

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

Do you have any health or obstetric concerns?

How did you hear about us?

Enrollment Agreement

The HypnoBirthing® Institute may contact you for quality assurance and research purposes. If you consent to be contacted now, please note that you are free to change your mind at any time. Be assured that we will not share your personal identifying information with anyone outside the HypnoBirthing® Institute for any purpose. Thank you for your help in collecting data to support the growth of HypnoBirthing®.

I agree to be contacted by the HypnoBirthing ® Institute

Yes

No

I hereby state that I am enrolling in the HypnoBirthing® 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 HypnoBirthing® 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 Full Name

Date

Cost

Tuition Fee of $350 - includes textbook, audio practice MP3’s, and spiral handout manual.

Doula Bundle Discount - HypnoBirthing® students who become our doula clients, will receive a $100 discount on doula services.

Send Payment to Finalize Registration

After submitting this registration form for the HypnoBirthing® course taught by the Doulaing Sisters, you must finalize your registration by sending $350 payment in full via one of the following methods:

Venmo - @megnbd711 (Family & Friends, please)
PayPal - @megnbd711 (Family & Friends, please)
Zelle - (216) 280-0665
Check - made payable to Megan DeHaven, 1803 Oakmont Rd., South Euclid, OH 44121

HypnoBirthing® Course Enrollment Form

This five-week course generally takes place on Thursday nights from 6:30pm - 9pm EST.