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Background Information

WIFE

Birth Date:*
Pregnant:
Due Date:
Nursing:
Are you a La Leche League Leader?
Social Security Number:*
Present Occupation:
Present Employer:
Employer Country:
Employer Address:
Employer City:
Employer State:
Employer ZIP:
Previous Occupation:
Educational Background:
Driver's License Number:
Professional Licenses(Please include numbers):
Languages Spoken(Other than English):
Hobbies:

HUSBAND (whether or not attending workshop)

Birth Date:
Will you be attending the workshop?
Will you be teaching with your wife?
Social Security Number:
Present Occupation:
Present Employer:
Employer Country:
Employer Address:
Employer City/State/ZIP:
Employer State:
Employer ZIP:
Eduational Background:
Professional Licenses(Please include numbers):
Languages Spoken:
Previous Occupation:
Driver's License:
Hobbies:

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Your Birth Experiences

Method(Bradley,...)	Teacher's Name	Birth Date	Baby's Name	Husband Present?	No Pain Meds for Labor?	No Pain Meds for Delivery?	No Pain Meds for Repair?	Still Nursing?/# months	Attended 12 Classes?

Priority acceptance is given to those individuals who have had an unmedicated birth and breastfed their baby and took a Bradley Class Series.

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Birth Education Experience

If you have already written a birth story that you would like to share with us please paste it here.

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Birth Education Experience

If you've taught childbirth classes before, tell us where and what method?

If you have had contact with Bradley^™ Affiliated teachers in the past, please give us the name of the one who influenced you the most in taking this workshop.

What do you feel you have going for you? Your strong points?

What topics do you feel you need help with?

Is The Bradley Method^® used in your area?(Please list teachers names)

Please list the names and ages of your children.

What would it mean to you ultimately to be able to teach The Bradley Method^®?

What are your thoughts and feelings about other childbirth methods?

In your mind, what is the difference between Bradley and Lamaze?

Will you be teaching for someone or a group, or Independently?(ex. a doctor's office.) If so for whom?

Will you be attending births?

How many birth have you been present at? (other than your own)

Hospital Home Birth Center How many babies have you caught?

How do you feel about home births, hospital birth and birth center births?

If you have attended a full 12 class series of Bradley classes, where and whom did you take them from?

Why should your application be accepted?

Have you read, "Husband-Coached Childbirth"?

Have you read "Natural Childbirth the Bradley^® Way?

Where did you get the books? (library, online, bookstore)

Please list any problems or special circumstances we should be aware of:

How did you hear about this workshop?(check all that apply)

Post Card: Email: Advertisement: Bradley Teacher: www.bradleybirth.com: Facebook:

Where else would you like to see advertising used for The Bradley Method^®?

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Statement of Policy

STATEMENT OF POLICY/CONTRACT

The American Academy of Husband-Coached Childbirth^®, (AAHCC), advocates The Bradley Method^® of Husband-Coached Childbirth. The terms, emblems, and intellectual properties of the AAHCC may be used only by our current members who are actually teaching The Bradley Method^®, using approved materials, paying dues, holding a current certificate and maintaining affiliation. Use of any of the above prior to receiving a current certificate would be unacceptable. ANY USE of the AAHCC^™ name, "The Bradley Method^®", "Husband-Coached Childbirth" and other related terms, emblems, and intellectual properties, MUST BE APPROVED IN WRITING BEFORE USE. Any other items must follow approval guidelines and be approved and filed promptly with the AAHCC before use and each year at renewal. The AAHCC trains and supports teachers; it does NOT employ teachers or offer childbirth classes.

AAHCC FUNCTIONS
The primary function of the AAHCC is to train instructors.
The AAHCC strives to support Instructors and the public by:

Setting standards for affiliation and for teaching The Bradley Method^®
Referring inquiries
Publishing AAHCC materials
Providing Online websites and support
International Directory
Providing public relations materials
Protecting and authorizing use of terms, emblems, etc. by teachers in approved manner
Authorizing use of title "AAHCC" with name by current affiliates
Offering reduced rates to teachers where possible

AAHCC AFFILIATION (Certification)
Affiliation with the American Academy of Husband-Coached Childbirth^® is a privilege, not a right! This affiliation must be applied for by individuals or couples after meeting all requirements, accepting all rules, policies, guidelines, and terms of the AAHCC, and successfully completing the teacher training process. Currently Affiliated Bradley™ teachers may use the phrase, "Affiliated Bradley^™ Instructor" or "Bradley^™ Certified Childbirth Educator". The title, "AAHCC" used after their name adds prestige and status while advising the public that they have received training and have met the high standards and requirements of the AAHCC. They may be used only while fully affiliated, and in conformance with this Statement of Policy. Bradley^™ affiliates may only teach in person classes. Bradley^™ affiliates may not make class recordings in any manner to teach via; phone, internet, dvd, etc.

Our primary goal is a healthy mother, healthy baby, and healthy family! (Bradley^™ teachers Do Not Practice Medicine or offer medical advice!)

Teach The Bradley Method^® exclusively (as stated in the Student Workbook, Teacher’s Manual and AAHCC Outlines) and no other childbirth method. Bradley^™ classes may not be taught in combination with any nonaffiliated teacher, or any other childbirth method. Ideas, concepts, and teaching aids are to be shared with AAHCC and become the intellectual property of the AAHCC, for development, public relations, and potentially to make available to our teachers.
1. Teach NATURAL CHILDBIRTH (with the primary goal of a healthy mother/ baby/family) as a simple, safe way of giving birth in the absence of medical complications.
2. Active participation of the HUSBAND as COACH/DOULA and other desired support person(s), when possible.
3. Excellent NUTRITION, the foundation of a healthy pregnancy.
4. AVOIDANCE of DRUGS during pregnancy, birth and breastfeeding, unless absolutely necessary.
5. TRAINING: Early/Healthy Pregnancy Classes followed by 12 consecutive weekly Bradley^™ classes starting in the fifth month, continuing until birth.
6. Classes and home practice of RELAXATION and NATURAL breathing.
7. Mothers "TUNING-IN" to their own body.
8. Immediate and continuous CONTACT between mother, new baby, and family.
9. BREASTFEEDING, beginning at birth.
10. POSITIVE communications and consumerism.
11. Parents taking RESPONSIBILITY for the safety of the birth place, procedures, birth attendants and emergency back-up facilities.
12. Parents EDUCATED about unexpected situations such as emergency childbirth or cesarean section
TRAIN anyone who genuinely desires this knowledge.
Encourage further learning, realizing that a good birth is only the beginning.
TEACH NORMALITY, DO NOT PRACTICE MEDICINE! Anyone offering medical advice or practicing medicine violates the purpose of the AAHCC, and the legal responsibility for such violation is entirely that individual’s.
Put your own FAMILY first.
Do not mix causes. Keep other interests SEPARATE and do not use The Bradley Method^® or the AAHCC to imply support of other activities. Do not cross advertise The Bradley Method^® with any other venture (i.e. non-Bradley^™ doula services, chiropractic, nursing, etc.) Use of The Bradley Method^® or AAHCC while advertising or promoting other related or nonrelated interests may imply support or endorsement of those activities and is a violation of the Statement of Policy.
Maintain high ethical and moral standards. As teachers your first RESPONSIBILITY is to your STUDENTS, regardless of who is paying for the classes.
Teachers should NOT COMPETE on the basis of price.
Teachers should SUPPORT and refer to other current AAHCC teachers listed on our website. Teachers are encouraged to support local teacher meetings following the AAHCC group and online guidelines.
Overly large CLASSES should be avoided. Ideal class size is from 3 to 6 couples to insure adequate interrelations with the teacher(s). Classes larger than 8 couples must be split.
Teachers should ENCOURAGE their students to attend teacher training workshops and become Bradley^™ teachers. Refer your students.
Teachers need to have a professional presence in dress, class environment, presentation, and be positive about TBM/AAHCC.

CONTINUING REQUIREMENTS

Use AAHCC materials. Official, current AAHCC Student Center/Student Workbook (curriculum) MUST be purchased ONLY from the AAHCC and given to every student taught. AAHCC coach cards and follow-up forms are also required to be given to each student, whether first-timer(s) or 12 week review/returning student(s) (subsequent births). (Submit copies of other than AAHCC materials and teaching ideas and concepts to be used in class before any use and each year at renewal).
Enter your students into the AAHCC Manage Students area via www.aahcc.com and make sure they have access to the Student Center on bradleybirth.com. Teachers are required to supply all student information for quality assurance and statistical analysis. AAHCC does not release or sell information to other parties. For the safety of AAHCC and our teachers, completed forms are required. HIPAA does not apply to the standard Bradley^™ class.
Pay dues and all other charges promptly and complete online renewal.
Strive for 90% spontaneous unmedicated births.
Train husbands, or other individuals designated by the student, as coaches/doulas.
Support the AAHCC by promoting and participating in Early/Healthy Pregnancy Classes, teachers meetings, public service and other activities.
All classes must be taught using AAHCC outlines. The Bradley Method^® class series is a twelve (12) week consecutive series of twelve (12) classes, the required standard. Private "crash courses" for one couple only with special needs may not be routine and may NOT be advertised/publicized. Crash courses may not be represented as a complete Bradley^™ class and more often result in a medicated birth. Every student must have access to Student Center which includes Bradley^™ Student Workbook.
Bradley^™ Birth Logs (with complete information including names, addresses, and email addresses) must be entered promptly on the AAHCC website for each birth. For quality assurance, statistical analysis, and the safety of AAHCC and our teachers, completed forms are required.
Teachers are required to have non-blocked phone numbers with message recording for the AAHCC and potential students. Return calls promptly, if necessary, refer students to www.bradleybirth.com and currently affiliated teachers.

The relationship between you and AAHCC shall be governed by the laws of the state of California. You and AAHCC agree to submit to the exclusive jurisdiction of the courts located within the county of Los Angeles, CA. Your affiliation is subject to suspension by AAHCC for violation of any of the terms of this Statement of Policy/Contract. This contract shall remain enforceable. You agree, once you are no longer associated, to discontinue the use of any materials and/or intellectual properties obtained from the AAHCC or you created during your affiliation. Remove all public notices of your prior affiliation with AAHCC/TBM. AAHCC dues, fees, tuition are not refundable. By participating in AAHCC activities, functions, and interactions you give AAHCC and its assigns the right to use your or your family member(s) comments and images for the purpose of education and promotion by AAHCC. If any provision of this Agreement is determined to be invalid under any applicable statute or rule of law, it is to that extent to be deemed omitted, and the balance of the Agreement shall remain enforceable.

RENEWAL These are current requirements, subject to change each year, and must be completed by each affiliated teaching entity each year following the first full year of affiliation. Any exceptions must be approved by the AAHCC. All members must complete online renewal and pay dues timely.

Re-read "Husband-Coached Childbirth" current edition.
Re-read "Assistant Coach's Manual".
Read additional book(s) related to childbirth education.
Teach a minimum of ten students each year (if possible).
Observe one birth (where possible).
Make sure you enter online, all students in the Manage Students area and birth logs (complete information required, including addresses and accurate email addresses).
Send in copies of all non-AAHCC handouts and teaching aids.
Support AAHCC activities in your area.
Attend at least one La Leche League meeting each year.
Observe one class taught by an affiliated AAHCC teacher (if available).

By entering initials below, I (we) agree to abide by the Statement of Policy and all Academy Policies, Rules, Guidelines, and Terms.

Initials: I Agree

Payment

$1,595.00. We accept Visa, M/C, and Discover. This will not be charged unless you are accepted to the program.
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Personal Information

Background Information

Your Birth Experiences

Birth Education Experience

Birth Education Experience

Statement of Policy

Payment