Course Enrollment

__________________________________________________________________________________ Mother’s Name __________________________________________________________________________________ Mailing Address _________________________________________ Preferred phone _______________________________________ Alternate phone _________________________________________ Preferred 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 whenyou begin classes?I wish to enroll for the class beginning (date):_____________ Location: ____________________ Where did you hear about Peaceful Birthing?: __________________________________________ First Baby?_______ If not, how many children and how were your other birthing experiences? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

Tuition is $325.

($100 non refundable deposit mailed with Course Enrollment form to above address, $225 payable to Janice Rex Weaver when class starts). Please be in touch if you prefer to use a credit card.

Classtuition includes textbook, audio practice CD’s, handouts, phone and email consults.T

HANK YOU

! I look forward to sharing classes with you.

Peaceful BirthingPeaceful BirthingPeaceful BirthingPeaceful Birthing

Gentle, relaxed birthing…..

the way nature intended

www.YourPeacefulBirthing.com

Janice Rex Weaver Janice Rex Weaver Janice Rex Weaver Janice Rex Weaver Certified HypnoBirthing Practitioner 3795 Delano Rd., Oxford, MI 48370607-329-5744yourpeacefulbirthing@gmail.com

Financial Policy for Peaceful Birthing ClassesFinancial Policy for Peaceful Birthing ClassesFinancial Policy for Peaceful Birthing ClassesFinancial Policy for Peaceful Birthing Classes

Payment:Payment:Payment:Payment: The fee for classes is $325. A $100 non-refundable deposit is required to holdyour place in class. You are not considered registered for class until your deposit has beenreceived. The balance of payment is due at the beginning of Class One. After deposit hasbeen paid, $45 weekly payments are available if helpful. Cash, checks, money orders orPayPal are accepted. I am able to directly accept credit card payments for classes at theMental Fitness Center in Rochester only.ReferralReferralReferralReferral: If you refer a friend to the same series that you are enrolling in, you will receive a$25 discount on your class fee.RefundsRefundsRefundsRefunds: Your deposit is not refundable for any reason. If you pay the entire fee before ourclass series begins, and must cancel, your fee will be refunded minus the $100 deposit.Once the classes have begun, I am unable to offer refunds if you are unable to complete theclass series.Insurance:Insurance:Insurance:Insurance: A receipt will be issued upon receipt of full payment if requested. You may submitthis receipt to your insurance company for reimbursement, if your carrier provides such. I donot accept assignment from insurance companies.Private Classes:Private Classes:Private Classes:Private Classes: If your schedule requires individual classes, please inquire aboutavailability. Private Class tuition is $385.RefreshersRefreshersRefreshersRefreshers: Current Students: Once you have completed your class series, you are welcometo sit in on any classes that I offer until your due date at no charge. Students who havepreviously taken HypnoBirthing classes with me are welcome to attend any or all classes 1-5at $35 each.