Doula Speed Dating - Doula Registration Form
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| Please select the dates you would like to register for. All dates listed are on Saturday at 4pm. Doulas arrive at 3:30 for orientation.
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| Feb 4, 2012 Apr 7, 2012 Jun 2, 2012 Aug 4, 2012 Oct 6 , 2012 Dec 1, 2012
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| First Name
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| Last Name
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| Business Name
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| Phone 1
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| Phone 2
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| Email
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| Promo Materials
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| Already sent or dropped off Sending or dropping off in the next three days Please supply Adar Birth Services with 12 copies of any promo materials (business cards, brochures, flyers, one-pagers, references, etc) that you would like parents to have.
These can be sent or dropped-off to:
Adar Birth Services
1911 Kitchener St
Vancouver, BC
V5L 2W6
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| Queer-friendly clarification
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| I confirm that I am LGBTTTQ-friendly as described below. What I mean by “Queer Friendly”
For some people, the term, “queer friendly” just means, “comfortable with two moms”. However, this event is open to the queer community as a whole, not just monogamous couples. Please take a moment to read the following excerpt from an ad I’m posting with x-tra west:
"Your doula will be accompanying you in one of the most meaningful and intimate moments of your life, so it is import to find one who is Queer Friendly and a good fit. Browsing through websites can be confusing and interviewing multiple doulas can be very time-consuming. The Doulas at this event have all been hand-selected for their dedication to birthing families and their LGBTQ-friendliness. Whether you are a queer single-mom, transgendered, intersex, an adoptive couple and birth mother, newlywed dykes, unconventional queer extended family, or a BDSM couple, you can feel confident coming to Doula Speed Dating."
Please let me know if you feel comfortable with that description. I really want to be sure that people from all parts of the LGBTQ spectrum feel welcome and not just “tolerated”.
If you have any questions, aren’t sure, etc, please let me know. I promise full confidentiality, so if you decide that you are not comfortable with it, you can say so without risking embarrassment or judgment.
Thanks,
Aimée
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| Training
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| I have completed training with a recognized doula training facility or program. All doulas must have completed training with a recognized doula training facility (i.e. DONA, CAPPA,
Childbirth International, Hypnobirthing, Birthing From Within, Wise Woman Way of Birth)
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| Certificate 1
| If you want to advertise your certification at Doula Speed Dating you need to provide proof of certification. Use this uploading section for any images of certificates issued by a recognized certifying body. If you are listed on the website of such a body, you can add the link in the next section.
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| Certificate 2
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| Certificate 3
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| Certificate 4
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| Certificate 5
| If you have more than 5 certificate that you want to upload, please email the remaining ones directly to info@AdarBirthServices.com
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| Certifying Body - Website 1
| If you are listed on the website of such a body, you can add the link(s) here.
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| Certifying Body - Website 2
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| Certifying Body - Website 3
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| Certifying Body - Website 4
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| Certifying Body - Website 5
| If you are listed on more than 5 websites, please email the remaining ones directly to info@AdarBirthServices.com
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| Availability
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| I have ample availability in the six months following each of the events that I am applying for. I have limited availability in six months following each of the events that I am applying for. My practice is full in the six months following each of the events that I am applying for.
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| Current Status
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| I am currently practicing as a doula I am not currently practicing as a doula
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| Bio (135 words max)
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| Please avoid repeating details that are already requested in this form such as training and certification.
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| Your headshot
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| Black and white or greyscale & high contrast is preferred.
Min 400x400 pixels, max 2MB.
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| Tagline (eg. "The best doula ever")
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| Website
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| Your logo
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| Areas of service
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| If there are some areas that you cover only partially, please be specific about this.
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| Active years as a doula
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| Births attended as a doula
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| Fee
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| Services included in fee
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| eg. home visits, lending library, photography, massage, birth plan assistance.
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| Services offered for an additional fee
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| References available
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| yes no
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| Birth story provided.
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| yes no (Some doulas will provide parents with a copy of the birth story as they saw it unfold.)
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| Backup arrangements
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| What are your backup arrangements? Do you work as a team with another doula or doulas? Do you rely on the wider doula community for backup? Do parents have the opportunity to meet your backup?
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| Maximum number of clients per month
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| Limitations (allergies, only do home births, etc)
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Image Verification
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