Blessed Start Registration (New) Please complete this registration form in order to access the Blessed Start Free Introductory Module, which is a prerequisite for the Blessed Start 10-Week Course. Your information is kept confidential and will only be used for communication and statistical purposes. If you already have an account on our website, please log in first and then return to this page to register for the course HERE (you must be logged into see the registration form).Username*Create your username for this website.Password*This password will be used to log into the website in order to access your courses. Enter Password Confirm Password Tell Us About YouName* First Last Estimated Due Date* Date Format: MM slash DD slash YYYY Email Address* Enter Email Confirm Email Phone Number*Please include the country code.Occupation*Nationality*Religion*IslamNumber of Prior Unmedicated Births*012345678910Number of Prior Medicated Vaginal Births*012345678910Number of Prior Cesarean Births*0123456Planned Birthplace*Birthing CenterHomeHospitalDo you plan to have anyone attend your birth besides the medical team?*e.g. your husband, doula, friend, family member, etc.YesNoIf so, who?Do you plan to breastfeed?*YesNoHow did you hear about the Blessed Start Course?*Word of Mouth from Family or FriendsEmail from AMANI BirthWhatsApp GroupFacebookInstagramTwitterOther Social MediaNone of the AbovePlease share any concerns or issues you may have about your upcoming birth.Have you read the AMANI Birth book?*YesNoAre you interested in training to become an AMANI Birth Childbirth Educator or Doula?*YesNoWill your husband participate in the course with you?*YesNoWould he be interested in joining a support group for AMANI Birth Fathers?*YesNoIf he's interested, please fill in his contact details below.Father's Name First Last Father's Email Father's Phone NumberPlease include the country code.CommentsThis field is for validation purposes and should be left unchanged.