Baby Maven’s Registration
Advanced payment required
Email: registration@babymaven.org  or Fax to: 208-248-4638  
Mail to: 2744 Burgener Blvd San Diego, CA 92110

Both Partners Names___________________________________________
 
Address______________________________________________________

City ______________________________ State ________Zip ___________ 

Phone(s) _________________________E-mail(s)____________________

Child’s due date or birthday (s) ___________________________________

Siblings name(s) age(s)_________________________________________

Emergency Contact Name & Number:
Anything additional we should note:

CLASS DATE(S) YOU’RE ATTENDING:  ______________________________
Prices:
    Childproofing Your Relationship 	2.5 hours			$75 per couple
        
    Bringing Baby Home			12 hours			$199 per couple
        includes books, materials & refreshments

    Bootie After Baby			2 hours			$35 pp $60/couple

    8 private consultation package					$499

Payment Options:   
______ I am paying with an enclosed check* made payable to:
           Carrie Grange Isaacson, LCSW
______ I am paying via cc # _ _ _ _ _ _ _ _ _  exp: ______ fax or call w/ cc #.
______ I am paying online via paypal & have included my email to be billed with an invoice.  

How did you hear about our program? 

__________________________________________________________________ 
	􀂃 Cancellation Policy: Registration Fees are refundable (less a 15%  service fee) when cancelled 7 days prior to workshop. Cancellations after this date are not eligible for a refund. Class may be canceled for insufficient enrolment and your payment will be fully refunded. *$25 returned check fee.
	􀂃  Please contact the instructor for questions about bringing and infant or about childcare resources.