Radical Rebirth Doula Rites of Passage (3-Day) Blend Retreat and/or The People's Perinatal HealthWorker (30-week Virtual) Doula program

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Virtual Program Class Dates: Please look below
In Person Retreat Dates: Please look below
Contact Doula Athena Guice by text at (754) 244-5082 or email Help@HijaDelSolBirths.com

Brought to you by Athena Gabriella Guice of Hija Del Sol Birth Services, LLC.
Rebirth name: Kasíké Padmé Olugbala Ma'at Taína

-PAYMENT INFORMATION BELOW TO SEND DEPOSIT AND/OR PAYMENT(S)-

Paypal Email: HijaDelSolMediaLLC@gmail.com OR @HijaDelSolBirths
Cashapp: $AthenaGuice
Bank Info (Biz name: Hija Del Sol Birth Services, LLC. Acct# 12-2441-3765)
Stripe Through HijaDelSolBirths.com or request invoice
Zelle Email: HijaDelSolMediaLLC@gmail.com (Least preferred option)

Email *

Do you know who Athena Guice is after watching "Get to Know Athena Guice" video on Youtube? (In your own words, what have you learned about Doula/Founder/Kasíke so far)

Radical Rebirth Doula - The People's Perinatal HealthWorker Program Registration

The completion of this form is necessary to enroll in program!!!

What is your full colonial (legal slave name i.e; Athena Gabriella Guice) name? *

Radical Rebirth name (Name you are given/take on when you release your slave name i.e; Kasíke Padmé Olugbala Ma'at Taína)

When were you born? (GREGORIAN CALENDAR) *

YYYY

Cultural Heritage/Nationality/How you Identify based on your knowledge of your Ancestry

How do you identify? (I'm just using terms I commonly hear)

Black Diaspora/Afrikan

Person of Color

Afro in America (African American)

Afro in Caribbean (African Caribbean)

Afro-Indigenous

Indigenous/Native

Latinx

Afro Latinx

Afro Mixed

Asiatic/Aboriginal

Eastern / Middle Eastern

White Mixed

White/Caucasian

European

European Jew

Other:

Clear selection

Your Mailing/Shipping Address for class manual, Certified Perinatal HealthWorker Badge, paperwork that may be sent to you, and/or anything else *

Phone # *

Have you watched orientation video yet? Click below *

Yes

Not alla it

I'm going to play it now while I fill out this registration form

Have you watched the Orientation Video?!?! (Click to watch if not)

If you missed the orientation on February 13th, don't worry, we recorded it for you! Ma'at, Athena Guice

Virtual Training: The People's Perinatal HealthWorker Program (24-Week Online Doula Training) AND/OR In-Person Training 3-Day blend Retreat in South Florida

Google

Instagram @yourdoulatraining

Instagram @Diosa__Athena

A friend/someone sent to me on Instagram/told me about it

Mailing list !

I don't even remember

Other:

Virtual Doula Training (65-Hour Program)

Virtual AND In-Person BLEND Doula Training (100-Hour Program)

Email Address here: *

WHICH training will you attend? *

I would like to take the virtual AND in-person 3-Day blend program $5,499: 100-HOUR DOULA RITES OF PASSAGE RETREAT

I would like to take Virtual Program (The People’s Perinatal HealthWorker Program) $3,399: 65-HOUR VIRTUAL DOULA TRAINING

Other:

Required

Dietary Lifestyle *

None ( I eat whatever)

Vegetarian

Vegan/Plantbased

Kosher

Gluten-free

Pescatarian

Option 7

Other:

T-Shirt Size (General men/unisex ) *

XXL

ALL Corporations/Organization(s) you work/have worked with- Paid and unpaid experiences still contribute to your knowledge base. PLEASE SHARE *

Special trainings and skills you bring with you: *

What is a Doula to you? What type of Doula do you envision yourself? *

Tell me about your culture, nationality, heritage, background, religion, lack of religion, spiritual relationship, upbringing, or anything you feel pulled to share that has contributed to how you show up in this world *

Why do you feel called to serve in this work and learn through Hija Del Sol Birth Services, LLC. programming? *

How will you be sending deposit and payments? (Put legal name and "deposit" or "payment #" in notes *

Bank Account (Biz name: Hija Del Sol Birth Services, LLC. Acct# 12-2441-3765)

CashApp $AthenaGuice

Zelle Email: HijaDelSolMediaLLC@gmail.com

Paypal Email: HijaDelSolMediaLLC@gmail.com

Send me an invoice using my email address I provided

I will set up recurring payments using my card and/or bank account through HijaDelSolBirths.com

I will be paying differently each time, I'm not sure but I will figure it out

Required

HIJA DEL SOL BIRTH SERVICES, LLC. PAYMENT PLAN COMMITMENT BELOW *

1 PAYMENT (FULL PAYMENT AS DEPOSIT AND COMPLETE PAYMENT)

2 PAYMENTS (Divide price of spot in 2)

3 PAYMENTS (Divide price of spot in 3)

4 PAYMENTS (Divide price of spot in 4)

5 PAYMENTS (Divide price of spot in 5)

6 PAYMENTS (Divide price of spot in 6)

I understand and agree that I must pay $DEPO$IT$ (1/6 or complete amount of spot) in USD to completely register for my training (virtual or in person) and all payments are NONREFUNDABLE. *

Yes I understand and agree

Required

Virtual Program Deposit and Payment Breakdown

Virtual & In Person BLEND 3-Day Retreat Deposit and Payment Breakdown

I understand my complete payment will be due before I can receive my certification. I understand I have been offered a payment plan arrangement prior to registering/enrolling in my doula training program. I UNDERSTAND ALL PAYMENTS ARE NONREFUNDABLE. *

Yes

Nope

I'm not sure

Required

How much is your spot in total? How much is your deposit (1/6 of complete spot)? When is complete payment due? *

I understand that I am responsible for my own airfare. *

Yes, I will be responsible for purchasing my own airline ticket to the retreat

I am taking the training virtually.

Do you feel pulled to share anything about you that wasn't asked? Share below *

WHAT QUESTIONS DO YOU HAVE?!?! *

Virtual Doula Training Information