Labor Doula Training Registration Form
Please fill in the form below.
Full Name
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First Name
Last Name
Please select the labor doula training you wish to attend.
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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
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Mobile Number
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Area Code
Phone Number
E-mail
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How did you hear about this training?
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Please describe your personal birth history (how many, your experience).
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How many births, other than your own, have you attended?
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Do you have experience in (choose all that apply):
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Vaginal birth
Cesarean section
VBAC (Vaginal Birth After Cesarean)
Unmedicated birth
Medicated Birth
Homebirth
Hopital birth
Birth 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.
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What other birth-related experience and/or certifications do you have? (LLL Leader, Childbirth Educator, Lactation Consultant, etc.)
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Please briefly describe your education and training, birth-related or otherwise.
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Do you speak any language, other than English, fluently? Please list language(s).
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Current employment? Prior employment?
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Would you characterize your learning style as primarily:
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Visual
Auditory
Kinesthetic
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.
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What do you hope to learn from this course?
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Do you have any allergies of which the group should be aware as we will be sharing snacks?
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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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