Professional Class Intake Form

Home
Our Classes
Our Team
Become an Educator
Contact
Blog

educator training Intake Form

We are so very much looking forward to joining you!

Please take a few minutes to read the Terms of Service and fill out the form below:

Click here to Read the terms of service

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Your Pronouns *

What town/city do you reside in? *

Have you taken My Powerful Birth for Professionals? *

Yes No, but I am registered before this training. No

What field of work are you in ? *

Doula (birth, full-spectrum, Postpartum, End of Life) Midwife/ Nurse Doctor Registered Counsellor Naturopath Therapist Other Allied Wellness professional

Check all that apply

What business are you joining us from? *

Where do you live and what area do you want to teach in/do you teach in (Our licence is available for in person classes). *

What is your intention of taking this class? *

To expand my knowledge To elevate my current curriculum To purchase a license and teach MPB Other

Are you already and educator? If so, what curriculum do you use? where did you get your certificate from? *

Are you interest in becoming an educator for My Powerful Birth? *

Where did you hear about us? *

Instagram Facebook Google Other Doula/Midwife/Allied-health professional Other

I have read and agree to the Terms of Service. *

Yes I agree No I do not agree

Click button above to read the Terms of Service

I agree to receiving marketing and promotional materials

Submit

Follow us on Instagram

@mypowerfulbirth

My Powerful Birth welcomes all families.

My Powerful Birth team is grateful to live, work and raise our children on the
unceded, ancestral lands of the Coast Salish and Sto:lo peoples.

Home
Our Classes
Our Team
Become an Educator
Contact
Blog