Doula Fund Application | BethanyKate Wellness

First name

Last name

Email

Phone

Address

Please upload a copy of your Drivers License or photo ID

What is your due date?

Please select all that apply

Please select all that apply pertaining to your race.

Please provide your Instagram handle, Facebook page, or other social media platform if you're open to us following your pregnancy journey

Who is the doula you intend to work with during your pregnancy and birth? *If you have not found a doula yet please answer with "still looking"

Please provide your doula's contact information. Email is preferred.

Please upload your signed contract with your preferred doula.

If you have not hired a doula yet, and are interested in working with Bethany as your doula, please indicate here.

By signing below you attest and agree to the following:

To the best of your knowledge, you are a qualifying applicant for The Doula Fund.
All the information provided on this form is true and accurate.
You understand that monies from The Doula Fund will be paid directly to your doula and never sent to you.
Your contract is between you and your doula. The Doula Fund does not guarantee birth outcomes nor the profiency or professionalism of the doula you hire. We cannot be held responsible if you do not receive the care you expected when hiring your doula.
Bethany Kate Wellness and The Doula Fund are not responsible if the doula you hire does not honor any portion of their contract with you. Any dispute over your contract must be handled between you and your doula.

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