Name
___________________________________ Date/Location Training
______________
Address
__________________________________ City/State/Zip
_____________________
Home Phone
______________________________ Work Phone
_______________________
Married? ______ Ever been
pregnant? _____ Number/Kinds of Births ________________
Why are you interested in labor
support training? ____________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Previous labor experience?
_______________________________________________________
_______________________________________________________________________________
Are you a Christian? _______
Please provide a brief testimony ________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Do you see labor support as
ministry? ____ How? ___________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Interested in Christian Doula
certification? ____ Christian Childbirth Ed. training/ cert?
___
Intersted in joining an
association of Christian birth professionals?
______________________
Do you have internet or email
access? _____ Email address: ___________________________
What do you hope to gain from
this training? _________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please return your form
to the address indicated for your training.
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