Contact Information

A red asterisk (*) indicates required field.

First Name *

Last Name *

Address, City, Province, Postal Code *

Mobile Number *

Home/Other Number

Email Address *

Website URL

Training Information

What training have you completed? *

Birth Doula

Postpartum Doula

OtherOther

Date training was completed. *

What is the name of the training organization? *

What is the name of the trainer? *

Upload a digital copy of your training certificate(s). *

Maximum upload size: 2MB

(If you have more than one training certificate, you may upload more than one file. Accepted file types include JPG, JPEG, JPE, GIF, PNG, DOC, ODT and PDF.)

Are you certified? *

Yes

No

In Progress

Certification organization: *

Certification Document *

Maximum upload size: 2MB

(Please upload a digital copy of your certification document. Accepted file types include JPG, JPEG, JPE, GIF, PNG, DOC, ODT and PDF.)

Experience and Skills

Do you work as a Birth Doula, Postpartum Doula, or both? *

Birth Doula

Postpartum Doula

Birth and Postpartum Doula

Birth Doulas: How many births have you attended? And in how many years? *

(For example: ____ births in ____ years.)

What is your current fee for basic birth doula services? *

This information is used to provide potential clients with a list of doulas that are in their price range.

Which hospitals/birth centres do you attend births at? *

Regina General Hospital

All Nations Healing Hospital (Fort Qu’Appelle)

Dr. F.H. Wigmore Regional Hospital (Moose Jaw)

St. Josephs Hospital (Estevan)

Yorkton Regional Health Centre (Yorkton)

Cypress Regional Hospital (Swift Current)

OtherOther

Postpartum Doulas: How many postpartum clients have you assisted? *

What is your hourly fee for postpartum doula services? *

Do you attend client meetings or postpartum visits outside of Regina?

Yes

No

Please list the communities you serve: *

For example: Pilot Butte, White City, Balgonie, Moose Jaw, etc.

Do you have any designations or skills pertaining to this profession?

For Example: Placenta Encapsulation, Childbirth Educator, IBCLC, Prenatal RMT, Babywearing Educator, etc.

Doulas of Regina is a volunteer organization. We need your support. Please indicate in which areas you would like to contribute.

(Select as many areas as you would like.)

What are you hoping to gain by being a member of Doulas of Regina? *

Additional Information

Do you identify as Aboriginal, Métis, or Inuit? *

Yes

No

Would you like to be listed as an Indigenous Doula on our website?

Yes

No

Relief Fund List (Optional)

To be added to the list of Doulas that provide services through the Relief Fund, you must read and agree to the contract.

I have read, understand, and agree to the terms set out in the Relief Fund Contract.

Yes, I agree.

Membership Agreement

I have read, understand, and agree to abide by the terms and conditions set out in the Membership Agreement document. *

Yes, I agree.

Become a Member

Membership Requirements:

Included in your annual membership:

Membership Application