Authorized Peanut Ball Trainer Application

Email

Daytime Phone

Evening Phone

Facebook name

Instagram name

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

What is your Profession?

Mom

Nurse

ICAN Member

Childbirth Educator

Doula

Other

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

No

Have you completed the Peanut Ball Ambassador Application?

Yes

No

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

Yes

No

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

No

Peanut Ball Trainer

Have you purchased the Authorized Peanut Ball Trainer Program in the store?

Yes

No

What type of training do you have? Mark all that Apply. If not, mark the last one.

Nurse

Nurse Educator

Doula Trainer

Childbirth Educator

Adult Education Instructor

Other

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.

I understand BEFORE starting the online course, I MUST complete my prerequisites of the following items:

I have already purchased the REQUIRED following items:

	Yes	No
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
Peanut Ball - 40 cm (our brand)
Peanut Ball - 50 cm (our brand)
Peanut Ball - 60 cm (our brand)
Peanut Ball - 70 cm (our brand)
"Give Birth with Balls" Brown Peanut Ball T-shirt
"Give Birth with Balls" Sticker
"Give Birth with Balls" Tote Bag

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

Rebozo - Tell us your top 5 colors (we can see what we have in stock)
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 (no discount available)

I understand:

	Yes	No
I am purchasing the above items for teaching.
I will receive a refund of 30 percent off a ONE-TIME order.
I can purchase optional items for 30 percent off when purchasing the required items.
No discount on peanut balls or online course.

I understand I MUST complete the following BEFORE I will receive a certificate and the Authorized Peanut Ball Trainer logo:

	Yes	No
Turn in all prerequisites before starting online course.
Purchase the required items above.
Complete all lessons in the online course.
Make a video to show how I teach peanut balls.
Complete all steps in the online course.

	Yes	No
A summary of what I learned and my implementation of learned knowledge on each individual item
37 Articles
14 Videos
4 Handouts
2 Podcasts
The Peanut Ball Book