Mother's Name *
Mother's Name
Partner's Name
Partner's Name
Additional support person attending the workshop (extra $50)
Additional support person attending the workshop (extra $50)
Due Date *
Due Date
Mother and Partner
Hospital/Birth Centre/Home and GP/Obstetrician/Private Midwife/Doula
Hospital classes/other antenatal classes and when
Agreement *
I am aware that participation in the workshop includes physical activity and will inform the teacher if I am a) suffering from any injury or illness, or any other conditions that may affect my participation; b) feeling unwell or experiencing any physical discomfort during the workshop