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Relief Fund Application

Name: Online Breastfeeding Class
Start: 2023-12-07
End: 2023-12-07
Location: Online

The purpose of the Doulas of Regina Relief Fund is to help subsidize the cost of professional doula services for women who need birth support and can otherwise not afford it. We strive to make a decision about all applications within one week.

Name *

Date of Birth *

Due Date *

Primary Phone # *

Other Phone #

Email Address *

Home Address *

City/Town *

Occupation *

Employer *

Marital Status *

Married/Common-Law

In a Relationship - Living Seperately

Single

Partner's Name (if applicable)

Partner's Occupation (if applicable)

Partner's Employer (if applicable)

What is your annual household income (gross)? *

< $20,000

$20,000 - $40,000

$40,000 - $60,000

$60,000 - $80,000

> $80,000

Have there been any changes to your financial situation in the last six months? If so, please explain. *

Have you taken, or are you planning to take, any prenatal education classes? *

Yes

Undecided

How much do you feel you could afford to pay for a doula's service? *

$25

$50

$100

$200

$300

OtherOther

Why do you feel you need funding from the Doulas of Regina Relief Fund? *

How do you feel a doula will benefit you at your birth? *

Declaration *

I have read and truthfully completed all of the information in this application.

Information

Birth Doulas
Postpartum Doulas
FAQs
Doulas and Dads/Partners

Upcoming Events

Dec 07 2023

Online Breastfeeding Class

Online

Dec 08 2023

Online Breastfeeding Class

Online

Dec 11 2023

Online Breastfeeding Class

Online

No event found!

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