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Postpartum Doula Training Registration Form. ALL FIELDS MUST BE COMPLETED!!!
Full Name
Address
City, State, Zip
Home Phone Number
Cell Phone Number
Email Address
Which Training Are You Registering For?
June 22-23, 2013 in Los Angeles, CA
August 9-10, 2013 in Valencia, CA
September 14-15, 2013 in Bellflower, CA
October 23-24, 2013 in Destin, FL
November 16-17, 2013 in Ventura, CA
August 3-4, 2013 in Cape Coral, FL
Why Do You Want to Become a Postpartum Doula?
List other Professional Affiliations/Certifications
How did you hear about this training?
Are you already a CAPPA Member?
Yes, I'm a CAPPA Member
No, but I'll become a member before training
Additional Comments/Questions
I understand that I am not registered in the training until I have sent the registration form AND paid for my training.
Understand
I understand that after filling out this form I need to go to the Pay for Your Training page to pay for my training via paypal or I need to mail a check to the instructor
Understand
I have read and agree to the Rules and Conditions Below
I Agree
I Do NOT Agree
I understand that there are no refunds for this training and I have read the refund policy in the Rules and Conditions Section below
I have read, understand, and agree
RULES AND CONDITIONS:
*By submitting this registration form you agree to the following:
  • I understand that there are no refunds for classes but I can transfer to another course with Darla Burns within 12 months of the original course date with approval from Darla Burns by paying a $50 transfer fee. If I fail to transfer to another training within 12 months and fail to pay the $50 transfer fee, I understand I will not receive any refunds for monies already paid to the instructor.
  • I understand that I must pay for my training in full at least 30 days before the training by going to www.douladarla.com/pay-for-your-training.html or by contacting the instructor to pay with a check.
  • I understand that I should not make non-refundable travel reservations until Darla Burns has confirmed the workshop 14 days prior to the course.
  • I understand that I must be a CAPPA member before I can become certified as a CAPPA  Postpartum Doula. (You can obtain membership at www.cappa.net)
As a participant of this training, I agree to allow Darla Burns/CAPPA  to do the following:
  1. Publish my name, address, phone number, and email address for the trainee class list & referral list. 
  2. Take photographs and video of the training which may include me, as well as allow the trainer and CAPPA to use these photographs and video for promotional purposes online and in print.
  3. Use quotes from my training evaluations (which I may fill out anonymously) for promotional purposes online and in print.

REFUNDS:
By registering and paying for this training, I understand that there are no refunds for this training. If student cannot attend this training, all funds will be held for 12 months to be applied to a future training taught by Darla Burns. To transfer to another training, I understand that I will need to pay a $50 transfer fee. If you fail to transfer to another training within 12 months and fail to pay the $50 transfer fee, all funds will forfeited.

POLICIES:

  • I understand that I may not record the training workshop (audio or video). 
  • I understand that I may not photograph any PowerPoint slides, training materials, certificates of completion or any other intellectual property belonging to CAPPA or the trainer. 
  • I may take photographs during the training only with the express permission of the trainer and the participants. I may not post any pictures on social media nor email any pictures from the training without express permission of the trainer and the persons in the photograph to do so.  No photographs may be used for advertising purposes, nor sold or transferred to any other party.
  • I may not reproduce, publish or distribute any materials in the training manual.
  • I may not reproduce, publish, photograph, share, email, or distribute any materials in the training binder (handouts) other than for the purpose of using them for my personal business as a postpartum doula. 
  • I understand that this course is only one step in becoming a CAPPA Certified Postpartum Doula.  There are several other steps that must be completed by the student after the training in order to be eligible for certification by CAPPA.
  • I understand that I must complete and return the Pre-Workshop Study Guide to Darla Burns via email or US mail no less than 7 days before the first day of the training. I understand that if I fail to return my completed PWSG to Darla on time, I will not be issued a Certificate of Completion at the end of the training.
  • I understand that I must enroll in CAPPA Academy to complete my certification. CAPPA Academy is an online certification component, where I can: receive step-by-step instructions on completing my certification, download the necessary forms for certification, take my multiple choice and essay exams. I understand that I only have access to CAPPA Academy for 1 year.
  • I understand that I must attend ALL days of the training.  If I miss any portion of the training, I will not receive a certificate of completion and/or Contact Hours.
  • I understand that due to the intense nature of the class and out of respect for the other students, no babies/children are allowed in the classroom during instruction time. Nursing babies may be brought to mom to nurse during breaks and/or lunch. 
  • I understand that I must be at least 18 years old to get certified as a CAPPA Postpartum Doula
 



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