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
Address (street, city, state, zip code)
Your answer
Country
Your answer
Phone Number (888-888-8888)
Your answer
Which 2017 workshop do you plan to attend?
Have you given birth to at least one child?
Home Births
Birth Center Births
Hospital Births
Children Breastfed
How long did you breastfeed each child?
Your answer
Please describe each birth (specifically note medications,interventions, outcomes, etc.) 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
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
Briefly explain why you would like to become a Birth Boot Camp instructor.
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: • The initial payment of $395 is required to hold your spot at the workshop. 50% of this fee is non‐refundable. $100 of the $800 Training Fee is non-refundable. • If cancellation is made within two weeks of the workshop, no refund will be given. • Payment will be applied to the Birth Boot Camp workshop chosen. If applicant desires to change their specified training date a $100 fee will be applied. All fees are forfeited if applicant does not attend a workshop within 12 months of applying. • If Birth Boot Camp cancels the workshop for any reason the entire fee will be refunded.
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.
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