BIG BELLY SERVICES CLASS
REGISTRATION FORM

Instructions:

1) To register, please complete this form and press the Submit button.

2) A deposit is due at the time of registration to secure your space in class.

3) Full payment is due two weeks prior to class beginning.

4) To pay a deposit or workshop fee using PayPal, follow the instructions on the registration confirmation page after pressing the Submit button.

5) If you would like to pay by check, please send to Big Belly Services, 2366 Eastlake Avenue E, Suite 428, Seattle, WA 98102.

6) Please read the Payment, Refund, and Cancellation policies below, before you register.

7) Not sure which class to register for? Read Choosing the Right Class for You at Big Belly Services.

Pregnant Woman's Name	*
Partner's Name
Due Date
Address	*
City	*
State	*
Zip	*
Email address	*
Phone 1	*
Phone 2
Phone 3
Is this your first child?		Yes No
If not, what are the age(s) of your other children?
Who is your midwife or doctor?
Where are you planning to have your baby?
How did you hear about this workshop?
Anything else you'd like us to know?

Which classes do you want to take?
Childbirth Preparation Classes:
7-week evening series ($75 deposit required)
Weekend Immersion ($75 deposit required)
Refresher class ($25 deposit required)
VBAC class ($25 deposit required)

After Birth Series: ($45 fee or deposit required)
Breastfeeding Basics
Postpartum Planning
Newborn Caring

One-time Classes:
Birth 101
Early Pregnancy Seminar - to register for the Early Pregnancy Seminar, go to the Great Starts website at www.greatstarts.org
Happiest Baby on the Block - to register for the Happiest Baby on the Block class, go to http://eastside-doula-care.ticketleap.com/the-happiest-baby-on-the-block/
For the following classes, you will be given payment instructions when you register:
Cloth Diapering
Carry Your Baby
Infant Massage Series

I have read and understand the Payment Policy, Refund Policy, and Cancellation Policy	*	Yes No
Payment Policy: Your payment reserves your spot in class. If you miss a class for any reason, no deduction or refund is made to your fees. Deposits are due at the time of registration. The balance of the class fee is due two weeks prior to the first class. An invoice will be sent as a reminder to you prior to payment due dates.

Refund Policy: Payments are refundable prior to two weeks before the class starts. After two weeks, you may receive a refund if your space in class is filled; otherwise, your payment will be forfeited. Refunds are not issued after a class has started. If you have concerns that your class is not meeting your needs, you must discuss this with your instructor and she will address that. All refunds will be issued via check. A $10 administrative fee is deducted from all refunds.

Note regarding PayPal payment refunds: Big Belly Services offers PayPal as a convenience for its customers. Big Belly Services absorbs the cost of PayPal fees when payments are made. However, if refunds are requested for a payment made with PayPal, the PayPal fees (approximately 3%) will be deducted from the refund amount.

Security Code	*