(Re)Birth Keeper Intake Form
Greetings & Gratitude! We appreciate your interest in working alongside us as we build a better community for Birth Care. This application is for those who are interested in training with and/or joining our Birth Care Collaborative. We are thrilled to be offering Birth & Postpartum Doula trainings! We are equally thrilled to onboard previously trained doulas to be a part of our collaborative and build support networks for Birth Keepers and families. Please take the time to fill out this form and give us a feel of who you are and what you are bringing to the collective birth space. We will contact you via your preferred contact method to get to know you a little more personally and to hold space for you to ask us questions and share anything you need to with us.

Our introductory course, "Foundations of a (Re)Birth Doula" launches in July 2022 and will be accessible to ALL of our members and doulas. This course serves to lay the foundations of what it means to be a (Re)Birth Doula and highlights the values and qualities of doula work. Our purpose in providing this course is to offer aspiring and practicing doulas the essential tools they need to provide quality support to birth givers and families. We also aim to give birthing people and families insight on what doula care is.  

Our second course, "The Prenatal Phase" launches August 2022. This course dives into the prenatal phase of birth keeping. In this course we will highlight the changing needs of the birthing person, the partner, and the siblings. We will go over the many different ways that we as birth keepers can support people and families during the prenatal phase of care on a mental, physical and spiritual level. We will also learn the basics of the physiological processes taking place during the prenatal phase to strengthen our knowledge of the female reproductive system and the transformative journey from zygote to infant.  Part 3, Childbirth Education, will go deeper into this transformational journey.

Prior to the launch dates you will receive all the information you need regarding our courses, our contractual agreements, our payment arrangements, our compensation rates & methods and anything further.

We are looking forward to (re)building more with you!
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What is your preferred name?
What are your preferred pronouns?
What email can we best reach you with?
What phone number can we best reach you with?
What is your preferred method of contact?
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Do you have a social media account that you would like to connect with us through?
When is your birth date? (MM/DD/YYYY)
In what city/state do you live?
Which course are you interested in taking? (Check all that apply)
What types of meet-ups, classes, and events are you most interested in attending?
Are you most interested in independent study or peer study groups?
Are you most interested in working at your own pace or working within a reasonable time frame that other people in your training group are working in?
Have you had any prior doula trainings or certifications? If so, what organizations did you receive training or certification through?
Do you have any other trainings, certifications, licenses, initiations or titles  relevant to the role of a BirthKeeper? (Lactation specialist, registered nurse, Iyanifa, massage therapist, herbalist, etc)
Do you serve any other roles in your community outside of the scope of a Birth Keeper?
What is your ideal birthing style and setting? (Home birth, hospital, natural, water, cesarean, interventions)
Is there a birthing style or setting that you would not want to be involved in? (Hospitals, free/unassisted birth, interventions)
Have you ever attended or assisted a birth (as a doula or simply as a supporter)?
Briefly tell us your reasons for becoming a doula?
What do you wish to gain from this training?
What strengths and qualities do you have that you would like to utilize in your birth work?
Are you a parent, guardian, or caretaker?
In what ways are you seeking support from your community?
Are there any resources you are seeking at this time?
Do you have a business or social media platform that we can contribute to and support?
Is there anything else you would like to share with us? Feel & be free!
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