Date & location of course
Where are you planning on giving birth?
Estimated due date
First or subsequent birth?
Name
*
First Name
Last Name
Age
Address
Postcode
Email Address
*
Phone Number
Occupation
Please rate the following questions on a scale strongly disagree to strongly agree?
1) Do you feel relaxed and focused when you think about birth?
2) Do you believe/trust that you can give birth naturally?
3) Do you believe that you will manage the power of your birth?
4) Do you believe that you will remain confident throughout your birth?
5) Do you agree that your birth partner understands how to fully support you during the birth?
6) Do you fully understand the process of birth so you can work with your birth?
Where did you learn/hear about the Hypnobirthing course?
Please tick the relevant boxes;
If Other, please state below;
Are you classed as low risk or high risk in your pregnancy?
If high risk, please state why
Pregnant with Twins
What drew you to doing the course?
What do you hope to gain from the course?
What's important to you in your pregnancy, your birth and postnatally?
How do you think you will cope with the power of your labour?
How would you like to prepare for your birth?
How would you like to feel about your birth?
What particular fears/worries/concerns do you have about birth?
How do you like to relax?
How do you know when you are relaxed?
Please describe any previous pregnancies and births. A brief description of how you felt and what happened?
Is there anything else you would like me to know about?
Declaration
*
By ticking this box, I am declaring that I fully understand the term & conditions of attending my hypnobirthing course.
TERMS & CONDITIONS
BOOKING
A booking does not constitute the creation of a contract and teacher reserves the right to decline to process a booking for any reason whatsoever. If the booking is not able to be fulfilled the teacher will promptly refund all monies.
PAYMENTS
A non-refundable deposit of £50 is to be paid to secure the booking of a Body to Baby course. The outstanding amount is then to be paid two weeks before the first course date starts.
If instalments of payment are required, please speak to Body to Baby to arrange this.
PARTICIPANT CANCELLATION
The fee will be repaid promptly and in full if your baby arrives before the course starts or in the very unlikely event of the course being cancelled. These are the only circumstances under which a refund will be made.
COURSE CANCELLATION
The teacher reserves the right to amend or cancel any course, course times, dates or published prices. Changes to course prices, times and dates will be advised before the course start date and any course already paid in full will not be subject to any price increase. Intellectual property, any recording or written material included as part of this course or arising from this course and all rights worldwide (including Intellectual Property Rights) relating thereto respectively are the sole property of Katherine Graves, KG Hypnobirthing Ltd, or Body to Baby, or others from whom such rights may be derived (whether or not protected by trademark and copyright laws) and may not be used other than for the personal use of the participant without obtaining prior written permission. The participant agrees not to record the course or any part thereof.
If any participants miss any part of the course for any reason, the teacher can arrange a catch up session with you, which will include an extra charge for the teachers time to do this.
DATA PROTECTION
You agree that the teacher shall hold on file and on computer and, in accordance with the Data Protection Act 1998 & GDPR regulations, you are able to view your individual file by giving no less than seven days' written notice. Just to inform you that photos maybe taken throughout the course, if you wish this not to happen, please inform your teacher on the day.
You agree to be automatically signed up for the monthly Body to Baby newsletter which will inform you of everything going on at Body to Baby including any promotions and discounts. If you wish for this not to happen, please inform a member of staff at Body to Baby to unsubscribe from receiving the monthly newsletter.
DISCLAIMER
Using KG Hypnobirthing techniques is not a substitute for the advice of or the presence during birth or any part of pregnancy or labour of a qualified medical practitioner, midwife or obstetrician. It does not represent in fact or otherwise an alternative to appropriate medical care or for professional medical advice in any way shape or form. Any questions or doubts that you have about the use of KG Hypnobirthing by you or any third party in any part should be discussed by you with your medical caregiver and the safety of or the appropriateness of this programme to you or any third party whom you represent be confirmed with your medical caregiver prior to undertaking the programme.
