You Must Send Me This Enrollment Form Before The First Day of Class
Enrollment Form-
(copy & paste and mail or email back this enrollment form)
Name:
(as you like it to be printed on your certificate)
E-mail:
Mailing address:
City: State: Zip:
Best number to contact you:
Workshop Date:
Workshop City:
Please write a few words about...
Why do you want to support postpartum women and
what 3 things do you want to learn from this workshop?
____________________________________________________________
This Postpartum Workshop is open to any and all participants
who have completed the Postpartum Doula Workshop prerequisites
required by DONA International by the first day of class.
[ ]Early Bird $450.00 (payment postmarked 30 days prior to workshop)
PayPal, Check or Money Order made out to: Rosemary Mason
Please do not send cash. $50.00 NSF fee will be added on all returned checks.
[ ] $400.00 Birth Doula (trained or certified- postmarked 30 days prior to workshop)
[ ] Payment Plan: $250.00 (postmarked 30 days prior to workshop)
Balance due on the first day of class in cash or check.
[ ] Late Bird: $500.00 per person
Accommodations are your responsibility and not part of your tuition.
_________________________________________________________________________
ENROLLMENT CHECKLIST
[ ] I will have my prerequisites completed by the first day of class.
[ ] I have enclosed a copy of my breastfeeding prerequisite.
[ ] I will bring a copy of my breastfeeding certificate to class on
the first day or proof that I have finished this prerequisite.
[ ] I will be bringing my in arms/sling nursing baby (3 months and under)
- Older children may come to class to nurse but will need additional outside support throughout the workshop.
- You do not need to purchase the DONA postpartum certification packet or become a DONA member prior to the workshop.
Mail payment and enrollment form to:
DONA International Postpartum Workshop
10026 Pinewood View
Santee, CA 92071-1112
Contact number: 619-448-MOMS(6667)
__________________________________________________________________
Once I receive your information I will send an email to you confirming your place in the class.
Please do not make travel plans until you have received confirmation from me.
Accommodations are your responsibility and not part of your tuition.
Cancellation Policy: Email or phone notification received more than 30 days
prior to workshop first day will receive a full refund, minus a $75.00 processing fee.
If you used PayPal their processing fee will be added to the $75.00. Less than 30
days, no refund, (instructor decides on special situations) but you may take the workshop
up to one year from original workshop date. If no notification of cancellation is received,
the entire fee is forfeited. Refund checks will be mailed on the first of each month.
$50.00 NSF fee will be added on all return checks. If four (4) or more students have not signed up
within thirty (30) days of the workshop date the workshop will be cancelled and full refunds made.
Please note that you MUST attend all sessions in order to receive a
"certificate of attendance" missing any portion of the workshop will
result in your forfeiting your certificate and tuition.
A $20.00 fee will be charged for a Certificate replacement.
________________________________________________________________________________
Requirements of Students taking the DONA
Postpartum Doula Workshop
To be sure that participants are adequately prepared for their
Postpartum Workshop, the following 2 requirements are required
before the first day of class.
Requirement 1. Required Reading:
From the DONA International required reading list,
the participant must have completed reading one
book from each of the 3 following categories.
You will not be tested on your book selection.
These books do not need to be new.
Book One: Becoming a Mother (please read one)
1.The New Mother: Eagan
2. Mothering the New Mother:Placksin
3. Misconceptions: Wolf
4. The Year after Childbirth: Kitzinger
5. Ourselves as Mothers:Kitzinger
Book Two:The Newborn (please read one)
1. Your Amazing Newborn: Klaus and Klaus
2. The Mind of Your Newborn Baby: Chamberlain
3. Infancy: Field
4. The Year After Childbirth: Kitzinger
5. Touchpoints: Brazelton
6. The Vidal Touch: Heller
7. The Baby Book: Sears
Book Three: Breastfeeding (please read one)
1. The Ultimate Breastfeeding Book of Answers: Newman
2. Dr. Jack Newman's Guide to Breastfeeding: Newman
3. The Breastfeeding Answer Book: La Leche League
4. Breastfeeding Made Simple: Morbacher and Kendall-Tackett
Some of these books can be purchased on the DONA International
website www.DONA.org through the Doula Boutique. Used books are also
available through Amazon.com or local book stores.
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Requirement 2. Breastfeeding Preparation:
The participant must have completed at least ONE of the options
listed below before attending the postpartum doula workshop.
Send a copy of your certificate with your enrollment form or bring the copy
to class on day one. If you don't get your copy in time, no worries,
I will honor your word.
Option1. Past certificate of attendance, a letter dated and signed by the
teacher stating your attendance. Le Leche League, CLC or CLE program
International breastfeeding class or a local nursing mother's group, a hospital based class, or a WIC class.
Prior attendance can not be dated more than 3 years.
The required topics at these classes should be:
1.Benefits of breastfeeding.
2.Basic anatomy and physiology (MER, supply and demand)
3.Infant's contribution and readiness to breastfeed (reflexes and feeding cues)
4.Latch
5.Early breastfeeding challenges (engorgement, nipple soreness, milk supply)
6.When to make referrals.
Option 2. (my preference) Completion of an on-line program breastfeeding study program:
www.leron-line.com click on "Training Programs" then "Lactation Management
for Doulas". Complete the $39.00 program. You only need to do complete the basic program
but you may do the advance program if you like. Please bring a copy of your certificate to class.
If you do not get your certificate in time, no worries I will honor your word.
Option 3. For a free on-line course: www.breastfeedingbasics.org.
You must register first. Put my name Rosemary Mason as your instructor. Your results will be emailed to me directly and I will then forward them to you.
Don't worry if you can not get your scores to print, (as they will be emailed to me)
you are still welcome in the class.
Option 4. Participation of a in-person breastfeeding workshop at any lactation educator's home, local hospital, LLL meeting, or WIC office, must be 3 hours in length no exception.
Have the instructor sign and date the attendance form (page 3) stating you observed the class and that the following topics were discussed.
1. Benefits of breastfeeding.
2. Basic anatomy and physiology (MER, supply and demand)
3. Infant's contribution and readiness to breastfeed (reflexes and feeding cues)
4. Latch
5. Early breastfeeding challenges (engorgement, nipple soreness, milk supply)
6. When to make referrals.
In Person Breastfeeding Course Observation Form
Within three (3) years of submitting application
Part One: To be completed by the observer (doula student)
Name:
Address:
Phone: Email:
Date of class observed:
Number of Hours Doula Student Observed:
Signature: Date:
Basic Outline of Breastfeeding Course: (may use back of this form or attach additional paper)
The following topics were discussed:
1. Benefits of Breastfeeding
2. Basic anatomy and physiology (MER, supply and demand)
3. Infant contribution and readiness to breastfeed (reflexes and feeding cues)
4. latch
5. Early breastfeeding challenges (engorgement, nipple soreness, milk supply)
6. When to make referrals
Part Two: To be completed by Breastfeeding Educator
The above named doula student did in fact attend this class as indicated above.
Name:
Address of class:
Phone: Email:
National Certifying Organization:
Signature: Date:
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