reg form

Big Belly Services

Birthing from Within, Childbirth Education, Parenting Preparation Seattle

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 (for Series and Intensives only).

3) Full payment is due two weeks prior to class beginning (except for Special Offerings).

4) To pay a deposit or a class fee using PayPal, simply return to this form after pressing the Submit button.

5) If you have already registered, just proceed to the bottom of the page and use the appropriate PayPal button.

6) You may also register or pay via regular mail; just follow the instructions at the bottom of this page.

7) Please read the Payment and Refund policies below.

Pregnant woman's name:

Partner's name:

Due date:

-- mm/dd/yy

Your mailing address:

(street)

(city, state, zip)

Your email address:

Your phone numbers:

home

work

cell

other

Is this your first child?

Yes No

If not, what are the age(s) of your other children?

Where are you planning to have your baby?

Who is your midwife or doctor?

Where did you hear about my classes?

Anything else you'd like me to know?

Which classes do you want to take?

        Childbirth Preparation Classes:

7-week evening series ($75 deposit required)

Weekend immersion     ($75 deposit required)

Lesbian Weekend        ($75 deposit required)

Refresher class               ($25deposit required)

VBAC class                  ($25deposit required)

      After Birth Series:

         The Newborn Care class on Monday, July 16, is full.
             Breastfeeding Basics
             Postpartum Planning

             Newborn Care



      One-time Classes:

             Early Pregnancy Seminar   To register the Early Pregnancy Seminar, go to the Great Starts website here.

             Diaper Free

         For the following classes, you will be given payment instructions when you register.

            Carrying Your Baby

            Infant Massage Series





To prevent automatic form submissions:

please enter the number you see in the picture below here:

You must click here to submit your registration form before making any payments:


WARNING: Before making any payments below, click the 'Submit' button above or your registration information will be lost! Please see Note below regarding PayPal payment refunds.

Childbirth Preparation Classes deposit - $75

Childbirth Preparation Classes full fee - $225

Childbirth Preparation Classes balance (after deposit) - $150

After-Birth Series - $100

After Birth One-Class fee - $35

Refresher or VBAC Class deposit - $25

Refresher or VBAC Class full fee - $75

Refresher or VBAC Class balance (after deposit) - $50

Diaper Free - $25

Or, you can open this form as a Word Document, print and complete it, and return along with your deposit to:

Carrie Kenner

Big Belly Services

5307 S. Alaska Street

Seattle, WA 98118

Payment Policy: 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. Sliding fees are available; please contact Carrie in advance of class to make any payment arrangements.

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.

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.