Accreditation Programme Registration Form

Accreditation Enrolment

Please fill out the form and pay the enrolment fee
Name*

First NameLast Name
E-mail*
example@example.com
Mobile number*
Address

Street Address

Street Address Line 2

CityCounty

Postcode
Date and venue of course attended: *
I wish to be accredited as a:*

Birth doulaPostnatal doulaBirth & Postnatal doula
Have you run your own business before?*

YesNoOther
Previous/current career:*
I want to work as a doula because...*
The strengths I believe I bring to the role are...*
The areas I feel I need to work on are...*
What are you looking for from your Doula Coach?*
After attending the training course are there any burning questions you have?*
Sign and agree*

I understand this information will be shared with my coach.
TERMS & CONDITIONS: The accreditation programme includes a 24-month period of coaching and mentoring, and this time period starts once you have signed up with your Doula Coach. Extending the time beyond 24 months will require you to re-apply to continue your accreditation journey (any jobs already signed off can be carried forward). There are circumstances where you can put your accreditation programme on-hold and pause it with the intention of continuing at a later date. These circumstances include bereavements, long-term health issues and maternity leave.*

I have read and understood the Terms & Conditions and by ticking this box I agree to them.