Registration Form - DONA Payment Arrangement Form

PAYMENT ARRANGEMENT FORM FOR REMAINING BALANCE

DONA Birth Doula Training Workshop

This Form is for the Remaining Balance ONLY. Your Deposit was Payment was confirmed & Paid when you Registered for your Class.

Your Full Name:(Required)

First Last

Preferred Phone #(Required)

I consent to receiving text messages so MC or my DONA Trainer can communication with me:(Required)

Yes

NO marketing material will be sent to you. Text is used as a form of communication to answer your questions or follow up with you regarding your Training Workshop Classes or DONA Certification.

Preferred Email:(Required)

I Registered for the Intro Class & DONA Birth Doula Training Workshop on: (Dates)

PAYMENT ARRANGEMENT TERMS FOR REMAINING BALANCE

Select all that Apply:(Required)

I received approval from Mother’s Care in writing (email or text) for a Payment Arrangement Plan.

I understand that the REMAINING BALANCE is NON-REFUNDABLE.

I understand that I will not receive a *Certificate of Attendance until the REMAINING BALANCE is PAID IN FULL.

I understand that I must provide a Credit/Debit Card even if I intend to pay with a Payment App.

I understand that there is an additional 3% surcharge FOR EACH charge made for Credit/Debit card payments.

I understand that there is NO additional surcharge fee for Zelle, Venmo or CashApp Payments.

I understand that I have up to **90 Days to complete all the Payments.

*The Certificate of Attendance is required to complete DONA Birth Doula Certification.

**90 Days from TODAY'S DATE.

How many Payments will you make to complete the REMAINING BALANCE?(Required)

Your answer should be one of the following: 2 Payments; 3 Payments; 4 Payments

MY PAYMENTS WILL BE MADE BY CC/DEBIT CARD:(Required)

I'm not paying with a CC/Debit Card

Visa

MasterCard

American Express

MY PAYMENTS WILL BE MADE BY PAYMENT APP:(Required)

I'm not paying with a Payment App

Zelle

Cash App

Venmo

PRICING & PAYMENT DATE BREAKDOWN:

FOR PAYMENT ARRANGEMENTS: You must be Registered for BOTH the "Introduction to Childbirth for Doulas" Class AND "DONA Birth Doula Training Workshop to have a Payment Arrangement.

- $ 350.00 - Total Non-Refundable Balance

CC/Debit card Payments: There is an Additional 3% Surcharge Fee charged for EACH payment. Fee NOT Included in amount above.

CC/Debit card Payments: MC will add the 3% Surcharge Fee when charging each payment. A receipt will be emailed to you separately when the charge is made.

Zelle, CashApp or Venmo Payments: There is NO additional Surcharge Fee.

YOU HAVE 90 DAYS FROM TODAY'S DATE TO COMPLETE YOUR REMAINING BALANCE

TODAY'S DATE:(Required)

DATE IN 90 DAYS:(Required)

Date of 1st Payment:

Amount of 1st Payment:

Date of 2nd Payment:

Amount of 2nd Payment:

Date of 3rd Payment:

Amount of 3rd Payment:

Date of 4th Payment:

Amount of 4th Payment:

PAYMENT OPTION 1 - Pay with a Credit/Debit Card

- Visa, MasterCard or American Express Accepted.

- You must include a Credit/Debit card on this form even if you intend pay using a Payment App.

- Your Credit/Debit card WILL NOT be charged UNLESS you do not make your payments on time.

Name on the Card:(Required)

Card Number:(Required)

Expiration Date:(Required)

Security Code:(Required)

Billing Address:(Required)

Street Address City State ZIP Code

PAYMENT OPTION 2 - Pay with Zelle, CashApp or Venmo

- You must include a Credit/Debit card on this form even if you intend pay using a Payment App.

- Your Credit/Debit card WILL NOT be charged UNLESS you do not make your payments on time.

SELECT PREFERRED APP:

ZELLE App - Connect to your Payment App (Recipient info below)

CASH App - Connect to your Payment App (Recipient info below)

VENMO App - Connect to your Payment App (Recipient info below)

ZELLE RECIPIENT INFO:	CASH APP RECIPIENT INFO:	VENMO RECIPIENT INFO:
Account Name: Marlo Robinson	Account Name: Marlo Robinson	Account Name: Marlo Robinson
Phone Number: 305.979.2823	$CashTag: $mamadoula	Venmo User Code: @Marlo-Robinson-6

WHO IS "MARLO ROBINSON"? Dr. Marlo Robinson is the Owner & President of MCDS and Lead DONA Birth Doula Trainer

REFUND-CANCELLATION POLICY & TRANSFER OF SERVICES:

ALL CLASSES ARE NON-REFUNDABLE - There are No Exceptions. While classes are non-refundable they are transferable. See below for details.

WHAT IF I MISS A CLASS OR A WHOLE CLASS SERIES? If you are unable to attend a class or class series you are registered to (whether Virtual or In-person), you can request to be transferred into another class at a later time. You have 1 year from the date of your paid registration to be transferred into another class. If this time expires, you must register again. You are responsible for the entire payment. No refund or discounts will be issued. To request a transfer to another class, please contact us as soon as possible, in writing by email.

TO CANCEL YOUR CLASS & REQUEST A TRANSFER INTO ANOTHER CLASS DATE: Email us at momsdoula@mcdsonlinedoulas.com.

ARE THERE ANY OCCASIONS WHERE THE CLASS MAY NEED TO BE CANCELLED/RESCHEDULED? There may be an occasion where, due to a circumstance beyond our control, the class may have to be rescheduled. In the event your class must be rescheduled we will contact you as soon as it is possible. You will be contacted and offered the choice to join the next scheduled class date. As our Refund-Cancellation Policy states, there are refunds. Instead, MC has 1 year from the date of your paid registration to transfer you into another class but will make every attempt possible to reschedule you into the closest date available.

IN-PERSON CLASS REGISTRANT MINIMUM - We require a minimum of 4 registrants for Trainings that occur in our Miami, FL location & 6 registrants for Trainings that occur in our Pembroke Pines, FL & Asheville, NC locations. If the minimum is not met, classes convert to a Virtual Class or Series. As our Refund-Cancellation Policy states, there are refunds or discounts. If you prefer not to attend the converted Virtual Class, you can ask to be transferred into the next available In-person class that occurs within 1 year from the date of your paid registration or attend a Virtual Class before this time expires.

REFUND & CANCELLATION POLICY ACKNOWLEDGMENT:(Required)

I have read and agree to the Registration Form's Refund & Cancellation Policy.

WHAT HAPPENS AFTER I SUBMIT THIS PAYMENT ARRANGMENT FORM FOR MY REMAINING BALANCE?

(1) An automatic Confirmation and Thank You message will appear on your screen signaling that your Form was received and will be reviewed by our MC Administrative Staff.

(2) A follow-up message will be generated and you will receive an emaill to the address you included on your form.

(3) The Official Confirmation Message that includes specific details about your Payment Arrangement including a confirmation of the dates and payment amounts will be emailed. The Official Confirmation will be sent to you within 72 hours.

(4) I PAID BY CREDIT/DEBIT CARD - Payment Receipt will be emailed to you separately each time your payments are charged. If you require an Invoice, please contact MC and request one: momsdoula@mcdsonlinedoulas.com

(5) I PAID WITH A PAYMENT APP - (Zelle, Cash App or Venmo) - Send your payment using the Recipient Info above. Each time your payments are made, a Payment Receipt will be sent to you separately from your App.

If you have any questions, please contact momsdoula@mcdsonlinedoulas.com or call us at 954.433.CARE (2273)

These forms are copyrighted and cannot be copied/used/reproduced without our authorization.

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