Doula Training Registration Form

Labor Doula Training Registration Form

Please fill in the form below.
Full Name*

First NameLast Name
Please select the labor doula training you wish to attend.*

December 3-4, 2022 (Live, online)
What would you like to be called at training? What name goes on your nametag?
How should your name appear on your certificate of attendance?
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Number*

Area CodePhone Number
E-mail*
How did you hear about this training?*
Please describe your personal birth history (how many, your experience).*
How many births, other than your own, have you attended?*
Do you have experience in (choose all that apply):*

Vaginal birthCesarean sectionVBAC (Vaginal Birth After Cesarean)Unmedicated birthMedicated BirthHomebirthHopital birthBirth Center
Have you ever experienced or witnessed a traumatic birth? If so, please describe briefly. Please describe what steps you have taken to process and heal from the trauma. *
What other birth-related experience and/or certifications do you have? (LLL Leader, Childbirth Educator, Lactation Consultant, etc.)*
Please briefly describe your education and training, birth-related or otherwise.*
Do you speak any language, other than English, fluently? Please list language(s).*
Current employment? Prior employment?*
Would you characterize your learning style as primarily:*

VisualAuditoryKinesthetic
How much of your required reading list (part of the CAPPA certification process) will you have completed before training? Please list the books you have read.*
What do you hope to learn from this course?*
Do you have any allergies of which the group should be aware as we will be sharing snacks?*
Is there anything else you would like for your trainer to know about you?
Copy the link and open payment page before submitting registration form: https://www.debbiehulldoula.com/ld-payment-page.html.
I verify that all of the information given in this application to register for the workshop is true. I affirm that I am at least 18 years old. I understand that training registration is not complete until payment has been received by Debbie Hull (return to https://www.debbiehulldoula.com/ld-payment-page.html and select the appropriate option). I understand that I am not registered until I have received confirmation from debbiehull.doula@gmail.com. I further affirm that by filling out and submitting this form, I agree to the terms and conditions as given above. My typed name in the space below is In lieu of a physical signature and indicates my agreement to these terms.*
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Labor Doula Training Registration Form