Authorized Peanut Ball Trainer Application

Trainer App_New

First Name

Last Name

Daytime Phone/Mobile

Evening Phone/Mobile

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Facebook Name

Instagram Name

Please share your professional website to promote you as a trainer.

Other Profession

You Must be a Peanut Ball Ambassador First

Make sure you complete the following assignments before completing the rest of the application.

Are you a Peanut Ball Ambassador?

Yes

Have you completed the Peanut Ball Ambassador Application?

Yes

Have you purchased the Peanut Ball Ambassador Program in the store?

Yes

Order Number for the Purchased the Peanut Ball Ambassador Program

How many Hospital or Birthing Center Peanut Ball Information Forms you have completed and returned?

1 Form

2 Forms

3 Forms

4 Forms

Is your name on the List of Peanut Ball Ambassadors on the website?

Yes

Peanut Ball Trainer

Have you purchased the Authorized Peanut Ball Trainer Course $500 in the store?

Yes

Order Number for Purchased Course

Other Profession

I understand:

I must send proof of certification of my education to premierbirthtools@gmail.com and other items that need to be submitted BEFORE the end of the course.

If I do not have any of the forementioned certifications, I will e-mail to qualify for an exception with my background to the aforementioned e-mail.

Have you have purchased the REQUIRED Peanut Ball Trainer Bag with supplies for $500:

Yes

Order Number for the Purchased Authorized Peanut Ball Trainer Bag

I have NOT purchased the REQUIRED Peanut Ball Trainer Bag and the following items for $500:

	Yes	No
“Give Birth with Balls” Tote Bag
Authorized Peanut Ball Trainer Pin
The Peanut Ball Book
Set of 14 Childbirth Charts (includes Set of 5 Peanut Ball Charts and MUST be laminated)
Home Birth Chart
Peanut Ball PowerPoint
“Give Birth with Balls” Brown Peanut Ball T-shirt- Tell us your size (we can see what we have in stock)
“Give Birth with Balls” Sticker
Rebozo- Tell us your top 5 colors (we can see what we have in stock)
Peanut Ball - 40 cm (our brand)
Peanut Ball - 50 cm (our brand)
Peanut Ball - 60 cm (our brand)
Peanut Ball - 70 cm (our brand)

I understand that I MUST complete the prerequisites of Part 1 of the online training on the following items BEFORE starting the Part 2 online course:

Optional Items to purchase with one-time 30% discount:

Rebozo In-Service Training Packages
Dancing for Birth DVD
Birth Ball - 65cm
Birth Ball Cover - also fits a 40cm Peanut Ball
Labor Support Forms: A Guide to Doula Charting (if you are a doula)

The Peanut Ball Book in color on Kindle on Amazon (no discount available) - mandatory to purchase anytime

	Yes	No
24 Articles
14 Videos
4 Handouts
2 Podcasts
The Peanut Ball Book