Enrollment Form Class fee per couple: $295 group class $395 private class. Enrollment Form Mother's Name * Partners Name Mailing Address * State & Postcode * Preferred Email * Alternate Email Is this your first baby? * Ages of other children? Preferred Phone * Alternate Phone Emergency Contact Name * Emergency Contact Phone * Birthing Assistant (if you have one) Relationship (Doula, Friend, Mum etc.) Name of Doctor (GP) * Doctor Address * Birthing Facility * Birthing Facility Address * When is baby expected? * How many weeks pregnant will you be when you begin classes? * I wish to enroll for class beginning (date): * Location * To confirm your enrollment please submit this form and make payment to the following: BSB: 034167 Account Number: 353057 Account Name: Zoe Strickland Please add your name as the reference. reCAPTCHA Submit If you are human, leave this field blank.