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Birth Boot Camp DOULA Training Registration Form

Once you submit your Registration, you will be contacted by the Doula Certification Coordinator to arrange payment for your respective Certification Fee, and provided with the next steps to finalize your registration.

Once your Registration is finalized, your Trainer will contact you to pay your Training Fee. You will be provided with your Training Modules once your payment has been made.

 

**All fees are non-refundable

Your Name

Birth Boot Camp Instructor Number, if applicable:

Your Email Address

Your Birthdate

Street Address

City

State

Zip Code

Country

Phone Number

Are you currently a birth professional?
YesNo

If yes, please list the organization(s), certifications, and licensing.

In your own words, briefly explain why you would like to become a Birth Boot Camp DOULA:

What are you most looking forward to learning at your Birth Boot Camp DOULA Training Workshop?

Who can we thank for referring you to the Birth Boot Camp doula Certification program?

Cancellation Policy: - All fees are non-refundable. If applicant desires to change to a later workshop date, a $250 fee will be applied. This $250 fee is due immediately to reserve the applicant’s spot in the new workshop.
I understand the cancellation policy.*

Terms: - I understand that the full Training Fee is due to the Trainer immediately. If a payment plan is needed, fees must be paid in full no later than 30 days prior to training. A $30 service fee applies for payment arrangements for the Training Fee. I understand that all pre-workshop requirements must be completed before attending the workshop. - As a participant of this training, I agree to allow Birth Boot Camp to publish my information: name, city, state, phone number, and email address for the online listing. - I verify that all of the information given in this application is true. - I understand that photographs and video will be taken the workshop which may include me. I agree to allow Birth Boot Camp to use these photographs and video for full promotional purposes both online and in print. - I will allow Birth Boot Camp to use quotes from my training evaluations - which I may fill out anonymously - for promotional purposes online and in print. - Birth Boot Camp reserves the right to reject any applications for Doula Certification.
I understand and agree to these terms

Non-compete/non-disclosure: Before completing your Birth Boot Camp DOULA training, you will be asked to sign a non-complete/non-disclosureagreement. The Birth Boot Camp family is large and spread across the globe. Signing of the non-compete/non-disclosure simply ensures protection of the brand for all of the hundreds of other birth professionals that depend on the name for their own financial security. This does not prevent birth work, should you leave the company. It does, however, mean that upon signing you agree to not intentionally harm the name of Birth Boot Camp, use copyrighted materials, conduct trainings, or start a competing company. We are happy to answer any questions you may have.
I understand the non-compete/non-disclosure agreement

I acknowledge and agree with all Fee Requirements and Policies, as listed above.

Please select the training workshop you would like to attend. If you decide to change your workshop date, a $250 fee applies.*

February 5th-7th, 2019 - San Antonio, TX (Opportunity to become a Birth Boot Camp Instructor will also be offered in San Antonio for an additional cost)February 7th-9th, 2019 - Guam (Opportunity to become a Birth Boot Camp Instructor will be available for an additional cost)February 22nd-24th, 2019 - Denver, COMarch 7th-9th, 2019 - Rainbow City, AL (Opportunity to become a Birth Boot Camp Instructor will be available for an additional cost)March 18th-20th, 2019 Oklahoma City, OK (Opportunity to become a Birth Boot Camp Instructor will also be offered in Oklahoma City)March 22nd-24th, 2019 - Scottsbluff, NEMarch 29th-31st, 2019 - Winston - Salem, NCApril 12th-14th, 2019 - Abilene, TXMay 13th-16th, 2019 - Remote TrainingJune 21st-23rd, 2019 - Denver, COJune 27th-29th, 2019 - Winchester, VA (Opportunity to become a Birth Boot Camp Instructor will be available for an additional cost.)June 28th-30th, 2019 - Nashville, TNJune 28th-30th, 2019 - Phoenix, AZ (Opportunity to become a Birth Boot Camp Instructor will also be offered in Phoenix)July 22nd-24th, 2019 - Oklahoma City, OK (Opportunity to become a Birth Boot Camp Instructor will also be offered in Oklahoma City)September 26th-28th, 2019 - Idaho Falls, IDSeptember 27th-29th, 2019 - New York, NYOctober 21st-23rd, 2019 - Tampa, FL (Opportunity to become a Birth Boot Camp Instructor will also be offered in Tampa)October 24th-26th, 2019 - Rainbow City, AL (Opportunity to become a Birth Boot Camp Instructor will be available for an additional cost.)November 7th-9th, 2019 - Salt Lake City, UTNovember 12th-14th, 2019 - Dallas, TXDecember 9th-12th, 2019 - Remote Training

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