Doula Services Liability Waiver

Release From Liability In entering a contract for Doula (Labor Support) Services with Voices of Eve: Birth Ministries on *

Pease enter date that you are filling this form out on.

I/We hereby acknowledge that during the performance period of this contract, services may be provided to me/us in my/our home, traveling to a medical facility, over the phone or online, and/or a hospital/birthing center. I/We understand that Voices of Eve: Birth Ministries has a limited role pursuant to the description of tasks outlined in the contract wherever services are provided to me/us. Voices of Eve:Birth Ministries has not represented to me/us that contracting for their services guarantees in any way a risk-free or emergency-free labor and birth experience. I/We understand that my/our doula(s) does not make medical or nursing decisions on my/our behalf, to include the decision when to seek medical care at a hospital when labor support services are provided in my/our home. When services are performed in a medical facility, I/we acknowledge that Voices of Eve:Birth Ministries is not responsible for the performance of clinical tasks to include medical or nursing decisions regarding the inclusion or exclusion of treatments available to me/us and my/our baby. *

I/We understand and acknowledge
I/We d not understand or acknowledge
I/We need more information

Now, therefore, in consideration of the above acknowledgements, I/we (both jointly and separately) on behalf of myself, ourselves, my/our heirs, administrators, personal representatives, executors, and assigns to RELEASE AND FOREVER DISCHARGE Voices of Eve:Birth Ministries from all damages or causes of actions, either at law or in equity, which I/we may have or acquire or which may accrue to me/us, my/our heirs, administrators, personal representatives, executors or assigns as a result of using the doula services of Voices of Eve:Birth Ministries. I/We intend this to be a COMPLETE RELEASE AND DISCHARGE them from all liability whatsoever. I/We have read all statements contained herein and I/we fully realize that I/we are signing a COMPLETE RELEASE AND BAR to any claims which I/we have or believe I/we have resulting from our contract for doula services. *

I/We understand and acknowledge
I/We do not understand or acknowledge
I/We need more information

Name of the primary client (expecting mother) *

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Last

Name of any persons signing this contract as well ( such as a spouse, partner, or gaurdian). *

First

Last

Email of the primary client *

Phone Number of the primary client. *

Phone