Christine Fischer-Rothman

447 8411 www.BFWNewEngland.com

BIRTHING FROM WITHINMentor and Doula

jpbirthingclasses@yahoo.com 617

Registration
BIRTHING FROM WITHIN Childbirth Classes: Group (3-5 Couples): Wednesdays June 6, 13, 20(6:30 to 9pm) and Saturdays June 9, 16 (5:30 to 9pm) $280 Group (3-5 Couples): 6 Wednesdays (6:30 to 9pm) starting September 5, 2012 $280 Private Class in your home (6 hours or according to needs, please call/email for pricing and details) Please let me know if you would like to take a class but the date/times does not work at all for you, sometimes I can modify times, or offer an extra class About You: Expectant Mothers Name Email Primary Phone Number Alternate Phone Number Address About Your Partner Name Email Phone Number

About Your pregnancy Approximate Due Date Are you a first time expectant Mother yes no Number and Ages of current Children (if applicable) Where do you plan to give birth Who is your doctor or midwife Additional Questions How did you find out about BIRTHING FROM WITHIN Childbirth Classes in JP?

Are you taking any other childbirth, Newborn or breastfeeding Class or have you taken any in the past? What are you and your partner hoping to focus on or learn about during our classes?

Is there anything else you would like me to know?

Payment: A non-refundable deposit of $50 is required at the time of registration to reserve your place in class, for both group and private classes. For group classes, a second non-refundable payment of $230 is due before the start of class on the first evening. If you are experiencing financial difficulties and cannot afford the full class fee, please contact me and we will work out a solution which works for both of us. I accept check or cash. Refunds and Absences: All payments are non-refundable and there are no refunds if you decide to withdraw from class. If you miss a class, I will do my best to share with you any information that we covered while you were absent. Cancellations: In case I need to cancel a class due to circumstances beyond my control (i.e. attending a birth, illness, inclement weather, etc.), I will reschedule class for a time that works for the majority of the group. I will contact you via email or a phone call as soon as possible. I also reserve the right to cancel or reschedule a series if enrollment is low. Your deposit will be returned to you in full if this occurs. Please mail your registration together with the deposit to Christine Fischer-Rothman 82 Dunster Rd Jamaica Plain, MA 02130 Or email me the filled out form to cbfisch@yahoo.com and mail the check no later than 2 weeks before start of class to save your spot.