Thanks for enrolling.

Woohoo, we can’t wait to delve into the Positive Birth Program with you. You selected bank deposit as your preferred payment method.

You can expect a confirmation email from us soon, detailing everything you need to know ahead of the course. First, to secure your spot please complete the form below and pay a deposit of $200* (or the full fee) to:

The Heal Zone
BNZ Bank
02-0466-0384296-02

Ref: [enter your name]

If you have any questions in the meantime, don’t hesitate to get in touch by clicking the button below.

*Please note the deposit is non-refundable, and a balance payment is required 7 days prior to course commencement.

Enrolment Form

Please complete this form to enrol in the course of your choice. We’ll be in touch shortly afterward with a booking confirmation. If you’d prefer to pay online by credit card, please return to the courses page, select the class you’d like to book and follow the prompts.

Course Type

Please select the course type you'd like to attend

Preferred Dates

If you selected Group, please enter the month/day you'd like to book e.g. August, Tuesdays. If you selected another option please list preferred dates and times to book.

Expectant Mothers Name

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Phone Number

Alternate Phone Number

Preferred Email Address

Alternate Email Address

Enter an alternate email address if you expect to use a different email address after your baby is born due to maternity leave or other circumstances.

Birth Partners Name

First Name

Last Name

Relationship to Expectant Mother

Estimated Due Date

Weeks Pregnant at Course Start Date

Care Provider

Enter the name of your lead care provider here

First Name

Last Name

Care Providers Title

e.g. Midwife, Doctor etc.

Care Providers Contact Number

Intended Place of Birth

If you selected 'Other' please specify

Is this your first, second or third pregnancy (or more)?

Is this birth a VBAC? (Vaginal Birth after Caesarean)

Special Notes

Is there any important information/medical conditions/psychological conditions or psychiatric treatment you need me to be aware of before classes commence?

Further Info

Is there anything else you'd like me to know ahead of the class?

If personally recommended, who can we thank?

Where did you hear about this course?

Special Dietary Requirements? (if applicable)