CAPPA Certified Labor Doula Contract of Agreement

CAPPA Certified Postpartum Doula – Contract of Agreement Thank you for choosing the path of becoming a Certified Postpartum Doula. This is a journey of a lifetime and I trust that each of you will go forward with making a huge impact in the lives of new parents. As a Postpartum Doula you are held to a high level of standards and as a CAPPA Postpartum Doula you are required to follow our Scope of Practice:

The Postpartum Doula: Assists the new mother, baby and the rest of her family within the first few weeks after the birth of the baby. The postpartum doula may offer the following: Breastfeeding education & assistance Newborn care instruction Household help Sibling Care Meal Preparation Errand Running Support and Guidance Parent Education Local resources

NOTE: Postpartum doulas do NOT offer any form of medical advice for mother or baby. They also do NOT perform clinical tasks on mother or baby. They are also NOT babysitters nor nannies!

During your training you will receive the tools necessary to begin the certification process with CAPPA. For starters, you have chosen to attend the training on the following dates:______Each class begins at 8:30 am and ends at 5:30 pm (this may vary depending on circumstances). At the start of class you will be given a curriculum and the training manual.

IMPORTANT!!!! Students desiring to pursue certification may contact CAPPA.net for current certification requirements. You will also need to become a member of CAPPA. You can do this at my training and a 1-year membership is only $55.00. If you are already a CAPPA member, please provide your membership number on your registration form

FEES: The workshop fee is $400.00 and includes the training manual. There are no refunds (unless I cancel the class due to low enrollment), however, should you need to cancel you can apply the fee towards any of my future trainings within twelve (12) months, should a training be available, if not all funds are forfeited. Initials: ______

Your space is not secured in the above-mentioned training until your deposit and this form is received and you have received a confirmation from me via email or by telephone. Please get those items to me quickly as space may be limited and I don’t want you to miss this opportunity! Also, if the number of required students isn’t met, I reserve the right to cancel class and you will receive notice prior to class date and I will refund all monies paid at that time. I look forward to meeting you and having you in class. Please do not hesitate to call with any questions that you may have.

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 Joanna Whitlow within 12 months with approval from Joanna Whitlow.  I understand that I must pay for my training in full at least 30 days before the training either by PayPal ([email protected]) or with a check.  I understand that I should not make non-refundable travel reservations until Joanna Whitlow has confirmed the workshop 14 days prior.  I understand that I must be a CAPPA member before I can be certified as a CAPPA Postpartum Doula. (You can obtain membership at www.cappa.net)  As a participant in this training I allow Joanna Whitlow/CAPPA to do the following: 1. Publish my name, address, phone number and email for the class attendee list and referral list 2. Take photographs of the training which may include me, as well as allow the trainer and CAPPA to use these photos for promotional purposes both on-line and in print. 3. Use quotes from my training evaluation (which I may fill out anonymously) for promotional purposes both on- line and in print.  I understand I may not record the training (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 express permission of the trainer and the other participants. I may not post any pictures on social networking sites or emails without the permission of the trainer and the persons in the photograph.  I may not reproduce, publish, or distribute any materials in the training manual.  I may not reproduce, publish, or distribute any materials from the certification packet other than for the purpose of fulfilling certification requirements. (ie: copying the evaluation forms for my clients to fill out)  I may not reproduce, publish, or photograph, share, email, or distribute any materials in the training binder/folder (handouts) other than for the purpose of using them for my own 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 attend all the 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 during breaks and/or lunch.  I understand that I must be at least 18 years old to get certified as a CAPPA Postpartum Doula.

Sincerely, Joanna Whitlow Certified Postpartum Doula Trainer, CAPPA (805) 570-3725 [email protected]

First Name Last Name Address City, State and Zip Telephone Number Alternative Number Email address: Other…

Your signature (by signing you agree to the terms herein) ______date:______