Instructor Application
We are excited that you want to join our team! Your first step is to complete this application. After submitting, you will get a response via email within 2 business days. If you have any questions, please email us at certification@birthbootcamp.com.
Name (first and last)
Your answer
Email address
Your answer
Date of birth
MM
/
DD
/
YYYY
Street
Your answer
City, State
Your answer
Zip Code
Your answer
Country
Your answer
Phone Number (888-888-8888)
Your answer
Which workshop do you plan to attend?
Have you had a baby?
If yes, please answer the following questions.
# of hospital births
# of birth center births
# of home births
# of cesarean births
# of children breastfed
How long did you breastfeed each child?
Your answer
If applicable, describe your birth and breastfeeding experience.
Your answer
Did you attend childbirth education classes prior to your own births?
If yes, please describe how they equipped you for birth.
Your answer
How have your own birth experiences impacted your desire to be involved in childbirth education? If you do not have children, why do you want to become a Childbirth Educator?
Your answer
What are your feelings regarding birth? Natural birth? Medicated birth? Cesarean birth?Breastfeeding?
Your answer
Birth Boot Camp taglines promote “amazing birth” and “amazing support” for births. At the root of our philosophy is that the majority of women can birth their babies vaginally and without medication. Does your philosophy and attitude towards birth align with that of Birth Boot Camp?
Your answer
Are you currently a birth professional?
If yes, please list the organization(s), certifications, and licensing.
Your answer
Number of couples served.
Your answer
Current field of employment
Your answer
What do you hope to learn at the Birth Boot Camp workshop?
Your answer
Who can we thank for referring you to the Birth Boot Camp Instructor Certification program?
Your answer
Payment Information: There are two payments that will need to be made. 1) $395 Certification Fee is paid to Birth Boot Camp to begin the program. 2) $800 Training Fee is paid to the Instructor Trainer who will be conducting the workshop you choose to attend.
CANCELLATION POLICY: All fees are non-refundable. If applicant desires to change to a later workshop date, a $250 fee will be applied. This $250 fee is due immediately to reserve the applicant’s spot in the new workshop.
TERMS: • I understand that all pre‐workshop requirements must be completed before attending the workshop. • I verify that all of the information given in this application is true. • I understand that photographs and video will be taken at the workshop which may include me. I agree to and allow Birth Boot Camp to use these photographs and video for promotional purposes online and in print. • I will allow Birth Boot Camp to use quotes from my training evaluations (which I may fill out anonymously) for promotional purposes online and in print. • Birth Boot Camp reserves the right to reject any applications for Instructor Certification.
Required
Non-compete/non-disclosure: Before completing your Birth Boot Camp instructor training, you will be asked to sign a non-compete/non-disclosure agreement. The Birth Boot Camp family is large and spread across the globe. Signing of the non-compete/non-disclosure simply ensures protection of the brand for all of the hundreds of other birth professionals that depend on the name for their own financial security. This does not prevent birth work, should you leave the company. It does, however, mean that upon signing, you agree not to intentionally harm the name of Birth Boot Camp, use copyrighted materials, conduct trainings or start a competing company. We are happy to answer any questions you may have.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms