1Terms & Conditions2About You3Birth Experience4Professional Experience By submitting this registration, you agree to the following Terms & Conditions: I agree to the following cancellation policy: If Rocky Mountain Doula cancels the workshop, students have the option of receiving a full refund or transferring to another workshop taught by Rocky Mountain Doula. All other cancellations will be charged a $75.00 processing fee. If the cancellation is made within three weeks of the workshop, no refund will be given. Cancellations prior to training workshop have the option of having payment applied to a training workshop given by Rocky Mountain Doula within 12 months. Only ONE transfer of registration is permitted. There is a $75.00 fee for registration transfer. If applicant does not transfer to a workshop within 12 months, all fees are forfeited. No-shows are not eligible for registration transfer or refund. I understand I should not make non-refundable travel arrangements unless I have received confirmation from Rocky Mountain Doula that the Skills Day workshop is confirmed. In the event of hazardous weather, “act of God”, or any other travel/public health/security issues making it impossible for Rocky Mountain Doula to hold the Skills Day workshop, a makeup option will be made available. Rocky Mountain Doula is not responsible for any travel expenses students may incur. I agree to allow Rocky Mountain Doula to do the following: Publish my name, phone number, and email address for the doula trainee class list & referral list. Take photographs of the Skills Day training which may include me, as well as allow Rocky Mountain Doula to use these photographs for promotional purposes online and in print. Use quotes from my training evaluations (which I may fill out anonymously) for promotional purposes online and in print. I agree to the following policies: I understand that I may not record the Skills Day training workshop (audio or video) or any portion of the online training program. I understand that I may not photograph/screenshot any PowerPoint slides, training materials, or any other intellectual property belonging to Rocky Mountain Doula. 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 handouts or manual other than for the purpose of using them for my personal business as a labor doula. I may take photographs of the instructor and the participants ONLY with their express permission. I may not use these photographs for any purpose other than personal use. They may not be used for any advertising purpose, nor sold or transferred to any other party without the express permission of the parties in the photograph. Babies/children are not permitted at Skills Day training. Nursing babies are welcome during lunch. Off-site childcare arrangements are the sole responsibility of the trainee. I understand that the instructor and Rocky Mountain Doula do not assume any liability for adverse reactions to foods consumed or anything one may come into contact with while at the Skills Day training or during any activity you may attend whether inside or outside the Skills Day training. I understand that I will receive an email confirmation from Rocky Mountain Doula within 48 hours of submitting this form. If I do not receive that confirmation, I will contact Rocky Mountain Doula at rockymtndoula@gmail.com to ensure that registration was received. I understand that I am not registered for this workshop until I have completed this registration AND the payment for the workshop fee has been received by Rocky Mountain Doula. I understand that I must be at least 18 years old to take a Rocky Mountain Doula Workshop. I verify that all of the information given in this application is true. I further affirm that my electronic signature is in lieu of my physical signature.Please sign your name below, indicating that you agree with the terms and conditions.* Reset signature Signature locked. Reset to sign again Full Name* Please put your name as you would like it to appear on your certificates.Nickname Pronouns Age* Email* Phone Number*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code This is where I will send your manual!How did you hear about this workshop? (Please be specific)*What do you hope to learn from this workshop?:*Would you characterize your learning style as primarily:* Visual Auditory Kinesthetic Personal Birth Experiences (children you have given birth to):Personal Birth Experiences (other people's births that you have attended):Number of Births Attended (excluding experiences giving birth yourself):* Please check which you have experience in:* Vaginal birth Caesarean birth VBAC Unmedicated Medicated Hospital birth Birth center Home birth None Have you experienced or witnessed a traumatic birth?* Yes No Please briefly describe:*Please describe what steps you have taken to process and heal from the trauma:* Do you work for a doula program?* Yes No Which one:* Are you a childbirth educator?* Yes No Organization:* Certified?:* Yes No Are you a lactation consultant, LLL leader, or do you teach breastfeeding classes?* Yes No Please specify:*Please briefly describe your education and training (birth-related & otherwise):*Current employment:*Prior employment:*Do you speak a foreign language/sign language?* Yes, fluently Yes, but not fluently No What language(s)?* Please check any that apply for you:*This information helps us accommodate your needs at Skills Day. I am pregnant I am nursing/pumping I require accommodations I do not require any accommodations