Mothers
Helper Birth Tub Rentals
www.Mothers-Helper.ca 519 256 3541
Surrender to the Soothing Relief of Waterâ
Agreement Form
Name:
_____________________________ Today’s Date: _______________
Address:
_______________________________________________
City: ______________ Province: _________ Postal:
______________
Phone (Day): ____________________(Eve): ____________________
(Fax): ______________________ Email__________________________________
Estimated Due Date: _____________ Which Baby?
1st_____2nd_____3rd____ 4th ____
Please
read the following information carefully and initial each stipulation:
|
Rental
Charge: $200.00 (or 190 if you have a doula or midwife) Extra Disposable liners are 15.00 extra if
you are planning on birthing in the tub. |
|
A
non-refundable $60 deposit, which applies to the rental, is required to
guarantee your rental period. |
|
(A) There will
be no reduction in fees if the Birth Pool is used and brought back within a
short amount of time. (B) SPA NOT USED - Refunds
will not be issued for any circumstances beyond our control (i.e.:
complications of preg (C)
Pool Not Received: The rental fee is non-refundable
with the exclusive exception that the baby is born before the Portable Labour
& Birth Pool actually arrives and then please let us know. And we will cancel your
reserved date. |
Mother’s Helper agrees to provide a sanitized and inspected Portable Labour & Birth Pool. If, for
any reason, a part of the Portable Labour & Birth Pool is not working
properly, it will be replaced ASAP at no charge to the client. Therefore, it is
required that the client unpacks and inspects the contents of the Pool kit upon
delivery to your home or pick-up. A trial run is recommended before the actual
use. If you have any questions regarding the set-up or use of the Pool
please contact me 519 256 3541
All Birth
Pools are planned to be rented a week and a half to two weeks prior to the
estimated due date. The rental period is over when the baby is born.
Please call us and let us know when the baby has been born. We then can arrange
a time for the Birth Pool to be returned or picked up. The kit needs to be
picked up or returned to our offices no later than 5 days after giving birth.
If we don’t receive the Pool back in our office within the specified time you may
be billed at $75.00 a week. We understand about special circumstances, but
please let us know what they are as soon as you can. Please understand that we
don’t charge for late babies, only procrastinating adults who, after the baby
is born, forget to call. YOU MUST CALL US AS SOON POSSIBLE AFTER YOU HAVE
THE BABY.
The Labour& Birth Pool kit is limited to
indoor use only.
Aqua Babies,
and/or any agent thereof, its members, employees, representatives, and
associates, as well as any Portable Labour & Birth Pool or equipment
manufacturer is hereby released and held harmless from any and all
responsibility or liability for complications, both maternal and infant,
including mortality, morbidity, or injury or physical property damage in
connection with the use of said portable Labour & Birth Pool Kit before,
during, and/or after labor and birth. You must notify us immediately of any
potential problems, otherwise we cannot be held responsible for such problems.
Client
agrees to pay the replacement cost of any part or equipment, which is directly
damaged by misuse or negligent handling while in their possession. This could
result from puncturing, melting, or ripping the Pool’s permanent liner; and
dropping or cracking the drain pump or heat pump. The replacement cost of any
damaged equipment or necessary additional cleaning of the Pool will be billed
to you. You will be advised of this charge in advance and an invoice itemizing
these charges will be mailed to you immediately.
I/we agree to the stipulations of this
agreement.
Signed
__________________________________________________________________
Make
Cheque payable to
Diane
Pepin
N9A
4R5