Name *

Address *

Phone Number *

Area of Current Work, or Experience and other courses attended? *

Mentoring you would like to book? *

Are you joining Doula UK *

Do you have any health issues or a disability?

What are you hoping to gain from mentoring? *

COST: £50 Registration Fee Please note: this is none refundable after 14 days and this is payable with submission of this form. Fee payable with Peer Group Mentoring ONLY is £60 *

Additional Payments: £40 per birth debrief (4 required), £40 per postnatal debrief (4 required, minimum 15 hours per job), £30 Sign off with certificate of mentoring complete - providing birth and Postnatal complete together. Total mentoring: £400. (these additional payments are paid after the job is complete and before your debrief). *

Cancellation of bookings; If for any reason the mentoring program is cancelled a full refund will be given. *

BIRTH MENTORING 1. 4 BIRTHS - WITH VARIETY OF home birth, hospital, MLU (where possible). 2. You can only accept one friend/relative that count towards recognition *

POSTNATAL MENTORING 1. 4 POSTNATAL (MIN 15 HOURS EACH) - (a minimum of two babies under six weeks, breastfeeding, bottle feeding, caesarean birth recovery Where possible) 2. You can only accept on friend/relative that count towards recognition *

Registration payment of £50 payment must be made along with this form, bookings will not be accepted if payment is not made. The next section will advise you how to make payment. £60 payable with peer mentoring ONLY. *