Supporting the birth community with information, education, services, and resources for positive birth experiences

Volunteer Intake Form

In order to particpate in the program, you must be a BABA member.

Are you a BABA member? Yes

If not, please visit www.bayareabirth.org/join_baba.html

Name:

Address:

Phone Numbers:

Home Phone:

Cell Phone:

Work Phone:

Email:

Name, Dates & Location of Doula Training Workshop:

Are You Certified? Yes No

Organization: Date:

If working towards certification, when do you anticipate completion?:

What areas are you willing to work in?

    Marin

    San Francisco

    San Mateo

    Santa Clara

    Alameda/East Bay

    Contra Costa
Are there areas/hospitals you prefer to work in?

Are there areas/hospitals you prefer NOT to work in?

Do you speak any languages other than English? If so, which?

List number of months or number of births you plan to work within the BABA volunteer doula program?

Do you agree to: (Please mark Y or N)
1) BABA Standards of Practice? Yes No

2) Become a member of BABA? Yes No

3) Provide BABA with doula workshop or certification documents within 2 weeks time? Yes No

4) Complete and return BABA evaluation forms within a timely manner (2 weeks)? Yes No

5) Be on call 24/7 for your client? Yes No

Within reasonable limits, do you agree to:

6) Contact the client within 48 hours of their initial call? Yes No

7) Promptly provide an interview? Yes No

8) If possible provide a prenatal and postpartum visit? Yes No

Do you plan to become a professional private-hire doula? Yes No

How did you hear about BABA?

Are you interested in other volunteer positions with BABA? Yes No

Birth Resources Join BABA BABA News Blog About Us Mission Pro Bono Program Doula Mentoring Peer Review Member Log-in Contact BABA Home

Bay Area Birth Association
www.bayareabirth.org

info@bayareabirth•org

Name:
Address:
Phone Numbers:
Home Phone:
Cell Phone:
Work Phone:
Email:
Name, Dates & Location of Doula Training Workshop:
Are You Certified? Yes No
Organization:	Date:
If working towards certification, when do you anticipate completion?:
What areas are you willing to work in? Marin San Francisco San Mateo Santa Clara Alameda/East Bay Contra Costa
Are there areas/hospitals you prefer to work in?
Are there areas/hospitals you prefer NOT to work in?
Do you speak any languages other than English? If so, which?
List number of months or number of births you plan to work within the BABA volunteer doula program?
Do you agree to: (Please mark Y or N) 1) BABA Standards of Practice? Yes No 2) Become a member of BABA? Yes No 3) Provide BABA with doula workshop or certification documents within 2 weeks time? Yes No 4) Complete and return BABA evaluation forms within a timely manner (2 weeks)? Yes No 5) Be on call 24/7 for your client? Yes No Within reasonable limits, do you agree to: 6) Contact the client within 48 hours of their initial call? Yes No 7) Promptly provide an interview? Yes No 8) If possible provide a prenatal and postpartum visit? Yes No
Do you plan to become a professional private-hire doula? Yes No
How did you hear about BABA?
Are you interested in other volunteer positions with BABA? Yes No