Rental Form

Bow Valley Birth Pool Rental Agreement

Thank-you for choosing to rent a birth pool from Bow Valley Birth Pool Rentals. Please complete the form below and we will be in contact to confirm your birth pool reservation.

Personal Information

Name

Address

Phone

Email:

Partner’s Name

Phone

Today’s Date

Pool Size Requested (Circle one): Regular or Mini

Estimated Birth Pool Rental Pick up date:

Birthing Information

Estimated Due Date Which Baby? (1st, 2nd, etc.)

Planned birth location:

Delivery or Pickup:

Do you have a history of birthing prior to your estimated due date? Yes No

If yes, how early?

DESCRIPTION

PRICE

TOTAL RENTAL FEE

Birth Pool in a Box (Including 1 disposable liner)

$250.00

Additional Liner for trial run

$60.00

Set-Up Fee (Optional - only at time of pool delivery)

$50.00

Delivery Fee– Canmore , Harvie Heights area

Banff, Dead Mans Flats,, Lac Des Arc, Exshaw

Cochrane & Lake Louise

Pick up – Canmore, Harvie Heights area

Banff, Dead Mans Flats, Lac Des Arc, Exshaw

Cochrane & Lake Louise

$25.00

$35.00

$75.00

$25.00

$75.00

Non-refundable deposit

$50.00

-$50.00

Total Cost of Rental

* All prices include GST

Fees may be paid by cash, cheque, money order or email transfer to BowValleyBirthPoolRentals@gmail.com Please make cheques payable to Bow Valley Birth Pool Rentals

Terms and Conditions

1. Bow Valley Birth Pool Rentals agrees to provide the client with a disinfected portable Birth Pool in a Box Rental and instructions (hereafter Birth Pool Rentals)

2. The client and their partner (hereafter collectively referred to as “Client”) shall indemnify and hold harmless Bow Valley Birth Pool Rentals and its employees, representatives, associates, agents, and third party contractors, including but not limited to any affiliated manufacturers against any and all claims (including all reasonable legal fees and disbursements incurred) and losses arising out of the use of the Birth Pool Rental.

3. Goods and services hereunder are provided as-is and Bow Valley Birth Pool Rentals makes no representations or warranties, express or implied, arising by law or otherwise with respect to such goods or services or this agreement, and disclaims all warranties as to merchantability, fitness for a particular purpose, or otherwise. In no event shall Bow Valley Birth Pool Rentals be liable to client or any third party for any special, punitive, incidental, indirect, or consequential damages, arising from any claimed breach of warranty, breach of contract, negligence, strict liability in tort, or any other legal theory, even if Bow Valley Birth Pool Rental has been advised of the possibility of such damages, all risks associated with the use of the Birth Pool Rentals shall be assumed by the client.

4. The Birth Pool Rentals shall only be used in accordance with this Agreement and the instructions provided with the Birth Pool Rentals. The Birth Pool Rentals is strictly for indoor use only.

5. Nothing herein shall be construed as medical advice or medical opinion. Client shall be responsible for consulting a qualified medical professional should they have any medical concerns associated with the use of the Birth Pool Rentals.

6. The rental period shall begin on the day the Birth Pool Rentals is delivered or picked up by the Client. Bow Valley Birth Pool Rentals suggest that the Client have their pool delivered before the end of the 38th week of pregnancy for home births, unless other arrangements have been agreed upon between Bow Valley Birth Pool Rentals..

7. The rental fee is on a per birth basis, for a period of approximately 2-3 weeks; however, the rental period may be subject to change depending on the demand by other clients of Bow Valley Birth Pool Rentals and availability of the Birth Pool Rental.

8. The client must contact Bow Valley Birth Pool Rentals within two days of giving birth to arrange for pick-up or drop off the Birth Pool Rental If Bow Valley Birth Pool Rental is not contacted within the specified time frame, an additional fee of $25 per day will be charged, starting from the baby’s date of birth. However, there is no additional charge for babies who decide to arrive later than the estimated due date, only for any delays in arranging pick-up of the Birth Pool Rental after baby is born.

9. Bow Valley Birth Pool Rentals clean and disinfect the Birth Pool Rental once the pool is returned. Drainage supplies are included so the client can remove water from the pool once use is complete.

10. There will be no reduction in fees if the Birth Pool Rental is returned.

11. The deposit $250 deposit is refundable

12. The Birth Pool Rental will be disinfected and inspected prior to delivery to the client, as per recommended cleaning procedures by Birth Pool in a Box.

13. The client shall be responsible for all costs associated with the repair or replacement of the Birth Pool Rental should the Birth Pool Rental be damaged by misuse or negligent mishandling of the Birth Pool Rental while in the Client’s possession.

14. This agreement may be cancelled by the Client or Bow Valley Birth Pool Rental up to one (1) week prior to the Birth Pool Rentals Delivery or PickupDate upon notice to the other party. Should the Client fail to notify Bow Valley Birth Pool Rentals of the cancellation one (1) week prior to Birth Pool Rentals Delivery/Pickup Date, a $50 cancellation fee, in addition to the $50 deposit shall be charged to the Client.

15. If labour begins before the scheduled Birth Pool Rentals Delivery Date, please contact Bow Valley Birth Pool Rentals and Bow Valley Birth Pool Rentals will to the best of their ability, deliver a Birth Pool Rental immediately, subject to availability.

16. Payment is required in full at the time of Birth Pool Rental pick up/ or delivery.. Refunds will not be issued for any circumstances, after the client has signed the delivery /pickup checklist.

Client Name Signature Date

Partner Name Signature Date

I/we, the undersigned, am 18 years of age or older, have read, understand and agree to the terms and conditions outlined above.

BowValleyBirthPoolRentals@gmail.com (403)707-6445 Canmore, AB

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Delivery/Pickup Checklist

The following checklist will be reviewed with the client upon delivery/Pickup of the Birth Pool Rental. Please contact Bow Valley Birth Pool Rentals immediately if any item is missing or damaged.

DELIVERY CHECKLIST

PICK-UP CHECKLIST

Inflatable Pool

Electric Inflate/Deflate Pump

White “Clean Water” Filling Hose

Grey “Dirty Water” Drainage Hose

Faucet Adaptor

Shower Adaptor

Submersible Drainage Pump

Disposable Liner

Tarp

* Optional additional liner

Disinfecting Wipes

Tarp

Birth Pool in a Box Instructions

Net/ Thermometer

I HAVE RECEIVED ALL PARTS IN GOOD CONDITION UNLESS OTHERWISE NOTED.

ALL PARTS WERE RETURNED AS LISTED, IN GOOD CONDITION, UNLESS OTHERWISE NOTED.

Client Name

Signature

Date

Bow Valley Birth Pool Rentals Representative

Signature

Date

BowValleyBirthPoolRentals@gmail.com (403)707-6445 Canmore, AB

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