Birth Pool Rental Agreement Name *Phone *Email *Partner's Name *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweEstimated Due Date: *Midwife's NameRental InformationPricing (not including tax):Birth Pool in a Box (includes liner): $150.00Terms and Conditions1. A licensed Midwife MUST be present when giving birth in the pool. 2. The pool is strictly limited to indoor use only. 3. Renter takes full responsibility for the manner in which the pool is used. 4. Renter will inspect all items in the pool kit upon arrival at home and notify Vintage*DOULA (the “Supplier”) immediately if there is a problem with any item in the kit. 5. Renter agrees to use a disposable liner when using the pool. The pool is NEVER to be used without a liner. 6. Renter agrees to pay for the replacement of the pool ($400) or any pool kit parts or accessories in the event they are lost or damaged, or rendered unusable for future renters. 7. The contract period (the “Contract Period”) will be the earlier of: a) a maximum of four weeks from the Birth Pool Delivery Date; or b) from the Birth Pool Delivery Date until a maximum of 48 hours after the birth has occurred, unless pre discussed arrangements are made. In most cases, Renter will arrange for the Birth Pool Pick-Up Date to be two weeks prior to the Estimated Due Date. Renter will be responsible to make arrangement with the Supplier for the Renter to pick-up the pool and for the Renter to drop-off the pool prior to the end of the Contract Period, by contacting the Supplier and giving a minimum of 48 hours prior notice in each case (the “Notice Deadline”). Notice may be given by telephone contact with the Supplier or by leaving a telephone message for the Supplier with reasonably detailed identification information. If notice is given to the Supplier by email, then Renter is responsible for also leaving a telephone message for the Supplier if receipt of the email is not acknowledged by Supplier before the Notice Deadline. There will be no reduction of the rental fee if the pool is returned before the end of the Contract Period. There will be an additional rental charge of $50.00 per week or part thereof beyond the Contract Period if arrangements have not been made with the Supplier by the Notice Deadline for the Renter to drop-off the pool by the expiry of the Contract Period. 8. The Supplier points out that there is a safety and hygiene risk if a pool remains filled for periods longer than 48 hours and the Supplier recommends against that. Renters are required to drain the pool themselves within a reasonable period after useage. Renters also agree to remove liner and clean pool thoroughly. Please ensure the pool has completely dried before placing back in it’s packaging. Renter assumes all risk of d!amage to the Supplier’s equipment and pool and the Renter’s residence. 9. Renter agrees to release and hold blameless and indemnify and save harmless the Supplier and its agents, employees, successors, assigns, officers, directors and associates, as well as any pool manufacturer, from any and all manner of actions, causes of action, proceedings, suits, debts, expenses, general damages, special damages, costs of defending any claim on a solicitor and own client basis, interest, claims, demands, responsibility and liability for maternal complications, infant mortality or morbidity, or injury to any or all persons and facilities connected with the use of the rented pool that may occur before, during and/or after labour and birth in the pool provided, including for any injury or illness or damage that may occur as a result of the pool remaining filled until Renter has been able to drain it, and including for any injury or illness to persons or damage to any property whatsoever that may occur as a result of or in the course of the pool being drained by any party and including for any damage or liability arising from the condition or strength of the floor structure in the residence in which the pool is filled or for any breach of terms of a residential tenancy contract or regulations of a landlord or the building in which the residential unit is located resulting from the placement and use of the pool within that residential unit. 10. Without restricting the generality of the foregoing, the Supplier will not be liable for any damage caused by improper use or misuse of the pool or its equipment or as a result of damage to the pool caused by its use, or as a result of its use in a room that does not structurally support the use of a birthing pool. 11. Upon receiving contract and payment, all birth pool reservations are NON REFUNDABLE. Regardless if the pool is not used, user changes their mind, or if birth plans change and usage is unable to happen. By submitting the contract, Renter reserves the pool, which holds the place for it’s rental, which can affect other possible renters from using the pool. Therefore, upon submission of contract, Renters are aware that all monies paid are NON REFUNDABLE in all circumstances.Standard Warnings and Safeguards1. Severe damage to the birth pool and personal harm may occur if the birth pool is not set up and used properly, and all of the enclosed instructions are not properly followed. 2. Pregnant women and persons suffering from heart disease, high or low blood pressure should not enter the pool without medical consultation and permission from their doctor/midwives. 3. Check birth pool temperature before use. The maximum safe water temperature should be established by your midwife and not exceed 98.6F. 4. Unsupervised use by children prohibited. Never leave children unattended without adult supervision in the vicinity of the filled birth pool. 5. Keep all foreign sharp objects out of the pool to protect against punctures or other damage to the liner and pool. 6. Please keep pets away from pool at all times. 7. DO NOT OVERFILL. Taking into consideration water displacement when individuals enter the pool, take care not to overfill the pool. 8. Avoid electric shock and personal injury by keeping all electrical devices, such as lamps and appliances, minimum of 10 feet away from the filled birth pool at all times.Consent * I (The UNDERSIGNED), am 18 years or older, acknowledge that I have read the contract and understand and agree to the terms outlined above. I accept all responsibility for the inherent risks to anyone and myself in my care with respect to the birth pool. Furthermore, I/we understand that my click-to-sign digital signature makes this contract legally binding.Full Name *Date *SubmitPlease do not fill in this field.