Registration Form: EOL Doula Training 3 day

Registration Form: EOL Doula Training September 27-29, 2024

This is the official registration form for the Inspired Endings End-of-Life Doula Training. It is necessary to complete and return it as soon as possible. Your space is reserved upon receipt of this form and your payment. Mahalo Nui Loa!
Email*
example@example.com
Full Name*

First NameLast Name
What would you like us to call you?*
What is your gender pronoun?*

She/HerHe/HimThey/ThemZeNo PreferenceOther
If you selected "other", please elaborate:*
Date of Birth*

MonthDayYear
Date
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone*
Alternate Phone Number*
What's the best way to contact you?*

PhoneTextEmail
How did you find out about this training?
Do you currently work in the health care field?*

YesNo
If yes, in what capacity?*

Massage TherapistEnergy WorkerCNANurseSocial WorkerPhysicianNaturopathMedical PersonnelAcupuncturistHospiceCaregiverOther
Is your intention to create a career/business as a death doula?

YesNoMaybe
Are you interested in weaving death doula skills into your current profession?

YesNoMaybe
How are you currently preparing to do this work?
What issues are you most sensitive to around grieving, loss and death? It’s good for us to have an awareness of this so you can be supported should they arise during this training.
Has someone close to you died in the past year? If so, please write briefly about this and what your relationship is to the deceased.
Are you currently caring for a terminally ill person? If so, please write briefly about this and what your relationship is to this person.
After death and before disposition of the body, doulas can support a family by assisting with honoring the body in a ritual preparation, which can include bathing the body and preparing it to lie in honor. Does this interest you?

YesNoUncertain
Why are you interested in supporting the dying and their loved ones?
The work we do in this training can be intense at times. Is there anything we need to know that will help us support you if you are feeling triggered? Please know this is confidential information.*
If you would like to share accommodations with a partner or friend please type their name below. We will do our best to make this happen. The best opportunity for this to happen is for the two of you to register as close together as possible.
Name of partner or friend
Refund Policy:

Included in your tuition is a 25% non-refundable, non-transferable cancellation fee.
- Cancellations received before August 16, 2024 will receive a full refund of tuition, less the 25% cancellation fee.
- Cancellations received before August 30, 2024 will receive a refund of 50% of tuition, less the 25% cancellation fee.
- There will be no refund for cancellations received on/after September 1, 2024.
Inspired Endings is committed to keeping those we care for safe from harm. We ask those who are taking the Death Doula training to also commit to doing no harm by following the most current safety protocols concerning the flu and Covid-19 as well as any other viral or bacterial infections that may affect our patients health and to consider professional, social and personal responsibility within the ethical dimension to safeguard people who are immune compromised. This may mean wearing a mask. Some may choose to get a vaccine and some may choose not to. The important thing is to always keep our patients safe. If you are not feeling well, or have been around others who are sick, please do not visit patients until you are sure you are not infectious and that you are feeling optimally well. Do you agree to follow current safety protocols to keep patients safe from harm? Please sign your name to indicate your agreement.*
Confidentiality: The Inspired Endings Death Doula training and the materials that make up the training are protected by copyright. Be mindful to only duplicate and use materials that you are given specific permission for. Please use the skills and everything you learn to grow and support those on their end of life journey. Please sign your name to indicate your agreement. *
Date of Signature*

MonthDayYear
Acknowledgment: I am responsible for my own personal safety and well-being during the course of the training. I will not hold the organizers or facilitators of this training nor any of the other participants responsible for any act that is or may be detrimental to my person or health in whatever way. I acknowledge all the information I have given to be true and transparent. Please sign your name to indicate your agreement.*
Date of Signature*

MonthDayYear
Refund Policy: Please sign your name to indicate your understanding of and agreement with the refund policy outlined in this registration form above. *
Date of Signature*

MonthDayYear
Mahalo Nui Loa
Thanks so much for completing this registration form!
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Registration Form: EOL Doula Training September 27-29, 2024

Refund Policy:

Mahalo Nui LoaThanks so much for completing this registration form!

Mahalo Nui Loa
Thanks so much for completing this registration form!