Active Birth Professional Training

Active Birth Professional Training
Part 1: Your Details
Full Name*

First NameLast Name
Your name as you would like it to appear on your certificate (if different)*
Date of Birth*

DayMonthYear
Date
Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any children?*

YesNo
If so, please tell us how old they are:
Please upload a recent photo of yourself. This will be used to help the teachers recognise you when you sign in for the course. It does not need to be a passport style photo and won't be shared during the course. You can also email your photo to jb@activebirthcentre.com if you prefer.

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Part 2: Your Application
What is the start date of the course you want to attend? (If the course date isn't online yet, just say the next available course).
Which modules are you applying for?*

Full teaching qualification - Module 1 (Active Birth Physiology) + Module 2 (Teaching Active Birth)Module 1 only (Active Birth Physiology)
If you are intending to teach Active Birth to parents, or use Active Birth in any other kind of antenatal teaching, please apply for both modules.
What is your current activity and/or involvement with pregnancy and birth?*
What would you like to get from this course?*
How do you plan to use the knowledge you gain from this course in your life/work?*
YOUR DATA SECURITY
Data security is very important to us. Information provided will only be used to contact you regarding this course, and you can opt out at any time. Your details will be kept safe and will only be available to the professional training partners. It will never be passed on to a third party.

CANCELLATION AND REFUND POLICY
Once booked, your place is reserved for you and is non-refundable except in exceptional extenuating circumstances such as a bereavement, serious illness or admission to hospital. In such an event please inform us as soon as you can. A deferment to the next course may be agreed. The final date for submitting requests for a deferment or a refund for the above reasons is the day before the start of the course.

OTHER TERMS & CONDITIONS

Please note that you will be required to sign a professional training agreement before you start the course. Teaching students will also need to sign the logo usage agreement. These documents will be sent to you, they may be updated but the current versions are linked here for your information.
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Active Birth Professional Training

Part 1: Your Details

Part 2: Your Application