Registration * indicates required field Personal Information Expectant Mother’s Name:* Email:* Cell:* Birth Coach/Partner/Husband/Other:* Email:* Cell:* Address:* Class Date Registering For:* Doctor/Midwife:* Planned Birth Place: Estimated Due Date: CLASS PAYMENT INFORMATION $130.00 Non-Refundable Deposit required to reserve your spot in class. ($130 debit/credit) Cash or Check payable to Yoga Janda Inc. To pay by credit card use link at bottom of the page. Payment with Registration Total Cost of Class + Materials = $395.00 (no cost to Babies in Bloom clients) **After the 1st class there will be no refunds. QUESTIONS AND INFORMATION All information is strictly confidential. If you are uncomfortable answering any questions, please leave them blank. 1. Do you have specific goals for the upcoming labor/birth/postpartum? 2. In what areas do you feel you need the most information? 3. What are your / coaches fears about the upcoming labor/ birth? 4. (MOM) Do you _ to read (reading)? loveliketoleratehate 4. (COACH)Do you _ to read (reading)? loveliketoleratehate 5. Are you experiencing any of the common pregnancy discomforts? (ie: leg cramps, headaches, heartburn, backache, constipation, insomnia, itching) 6. Are you being treated for any more serious health conditions? (ie: high blood pressure, anemia, diabetes, epilepsy, asthma, etc.) 7. Do you smoke cigarettes? yesno 8. Do you spend time with Someone who smokes? yesno 9. Do you take over-the-counter drugs or prescription drugs? yesno 10. Do you drink alcohol? yesno 11. Do you have a cat? yesno 12. Do you wear your seat belt? yesno 13. Do you lie on your back? yesno 14. What is your exercise routine? 15. How do you rate your eating habits? (quantity/quality) 16. What are your feelings about weight gain? 17. Do you: drink caffeinelimit your caloriestake vitamins 18. Do you: have a job?plan to return to work after the baby is born? What is your occupation? What is your coach’s occupation? 19. What are your feelings about breastfeeding? 20. Have you had breast surgery of any kind? If so, please explain. I understand that the information given in each class is of great importance to decisions we may be making concerning the health of mother and baby. Attending every class is ideal. If one of you can't attend, I encourage one of you to attend on your own or bring a substitute coach. Payment/Deposit Due with Registration https://venmo.com/Liza-Janda or Paypal - https://yogajanda.com/bradley-method/ Best Prenatal Videos Latest Yoga News Pregnancy Nutrition: EVERY CELL FORMED FROM PROTEIN Pregnancy Nausea and Vomiting – Weird & Effective Remedies Breast Pumps – Do I Need One? Which One? The Most Significant Component of a Healthy Pregnancy Podcast Interview with Lindsey Paczkowski Yoga CategoriesYoga Categories Select Category acupuncture (3) Acupuncture in pregnancy (2) Anemia/Fatigue (3) Anemia/Fatigue (3) Anxiety About Childbirth (1) Aromatherapy (2) Articles (9) baby (5) Backache in Pregnancy (16) Being Pregnant (7) Benefits of Yoga (6) Best Cesareans Possible Positive Birth Experiences (12) Birth (3) Birth Plans (9) Bradley Method (39) Breastfeeding (10) Breech (1) Bringing Baby Home Postpartum Care (17) Carpal Tunnel Syndrome in pregnancy (3) Coaching a Labor/Birth (3) Constipation and pregnancy (4) constipation in pregnancy (4) Doulas I Know (8) Easier Labor & Birth (27) Epidurals (2) Essential Oils (4) First Stage Labor (4) First Trimester Solutions (1) Group B Strep & Pregnancy (3) Guided Imagery For Relaxation Practice (14) Healing From Traumatic Birth (11) Heartburn (2) Hemorrhoids in Pregnancy and Birth (2) Hospital Bag (1) How To Avoid A Labor Induction (10) How to Have a Natural Birth (3) How To Turn A Breech Baby (1) Induction of Labor (7) Informed Consent Questions (3) Itching Skin (2) Labor (9) Labor and Birth Advice (46) Leg Cramps (2) Massage for Pregnancy and labor (3) Medications in Labor Risk ad Benefits (2) Microbiome/baby’s immune system (1) MTHFR gene mutation and pregnancy (1) Natural birth (2) Natural Birth Stories (37) Natural Induction (3) Natural Induction of Labor (2) Nausea and vomiting (1) Nutrition (5) Nutrition For a Healthy Pregnancy (15) Nutrition in Pregnancy (2) Parenting (3) Positive Birth Stories (10) Positive Birth Stories (8) Postpartum (10) Postpartum Depression (2) pregnancy (4) Pregnancy Checklists (7) Pregnancy headaches. (4) Pregnant in San Diego (13) Questions to Ask Your Doctor or Midwife (4) Recipes For a Healthy Pregnancy (15) Recommended Reading For Pregnancy (3) Sciatica in Pregnancy Solutions (2) Sleep & Pregnancy (7) Stay Fit While Traveling (2) Stretches – Basic (1) studio (2) Swelling (3) Swelling in Pregnancy (2) Time to go to the Hospital (1) Uncategorized (36) Vaginal Steaming (1) VBAC (5) What to Eat & Drink in Labor (1) When to Leave for Your Birth Place (2) Yoga and Pregnancy (47) yoga class (16) Yoga in the Workplace (9) YouTube Channel Videos (3)