Birth Pool Rental Agreement

Name: _________________________

Due Date: ____________

Desired Rental Period:_________________

Address: ___________________________

Phone:________________

E-mail:___________________

Please tell me how you found me:_______________________

Please read the following:

• The rental period for the birth pool is 4 weeks. Billing starts from the day of receipt of the pool. $50.00 per week may be charged if you keep the birth pool beyond the end of the rental period.

• There will be no reduction in fees if the pool is used and returned in a short period of time.

 • There will be no refund for circumstances beyond our control (i.e. the pool is not used for labor or birth).

 • Refund of the balance owing will be issued only if the following occurs. (1.) The pool arrives in unusable condition. (2.) The baby is born prior to 36 weeks.

 • The $50 booking deposit is non refundable

 • The client agrees to take full responsibility for the manner and purpose for which the pool is used, and it is limited to indoor use. Also, the client agrees to pay for the repair or replacement of the pool and/or accessories in the event they are damaged and rendered unusable by misuse or negligent handling while in the clientʼs possession. Damage can result from puncture, melting, ripping of the pool or breakage of accessories.

 • Prior to its return, the pool and accessories should be cleaned and dried by the client. An additional charge will be incurred if the pool or its accessories require additional cleaning beyond typical sanitization.

 • The pool must be used with the included form-fitting disposable liner. Please initial here indicating you understand the liner is required during use of the pool. _____________

 • The rental fee does not include a new lead-free hose, sink adapter, or water pump.

 • It is important to familiarize yourself with the pool and accessories prior to the onset of labor. Read and follow the instructions included with the pool. Practice setting up the pool to familiarize yourself with the process. Check that the faucet adapter will fit a faucet in your home. The included adapter fits most standard faucets. It it does not fit yours, you may find an alternative at a good hardware store.

 • Mama Led Birth, LLC and/or its agents, members, employees and associates, as well as the pool manufacturer are hereby released and held harmless from any and all responsibility or liability for both maternal and infant complications, including mortality or morbidity, or injury or physical property damage to any or all persons connected with the use of the rented pool, that may occur before, during and/or after labor and birth.

 I understand the above-listed conditions, and I agree to rent a birthing pool from Mama Led Birth, LLC at a cost of _____________ for four weeks.

 Deposit at the Time of Booking: $50 non-refundable

 Balance Due at receipt of Pool: _____________ and cost of any options chosen _____________ 

Total payment made:_____________ 

Options: (circle if desired)

TENs Unit - $40

Peanut Ball - $15

Pickup/Drop Off service outside of 20 miles from East Berlin, PA - $75

______________________ 

Signature

___________

Date