My Obligations to You * A sibling support doula is present during labor and birth and can offer complete emotional support for your older child(ren). The sibling doula is available to care for older brothers and sisters while their parents are busy having a baby. Whether planning for a home or hospital birth, and for children to be present or not, it’s imperative that someone be solely responsible for the older siblings. The sibling doula comes to your house to watch your child(ren) where it’s most comfortable or can accompany the family to the birthplace, ready to whisk away any little ones who find they are not completely on board with all of the exciting activity of labor and delivery. She is also an experienced labor and postpartum doula and provides a calm and confident presence for all. At all times I will abide by my Code of Ethics and Standards of Practice. As your doula I will: *Be on call 24/7 in your due date of 38-42 weeks or the agreed-upon date range. *Arrive at your home within 120 minutes of being requested. *Respect your privacy in all aspects of your pregnancy, birth, and the postpartum period *Work to maintain a fun and positive environment for your children. *Use only positive reinforcement and redirection for behavior correction. *Remain in the home with children until agreed upon person arrives to relieve me. * I do no: * Transport children in my vehicle. *Perform clinical tasks. *Make decisions for you. I understand the above obligations Your Obligations * In order to help you have the best birth experience, I ask that you and your partner do the following: * Complete a childbirth education course and discuss your birth plan with me. * Be responsible for your personal health for a healthier pregnancy and better birth experience. * Tour your chosen birthplace. * Call me when you are in labor and allow me approximately two hours to reach you. * Disclose any communicable illnesses you may have so that I may take precautions. I understand and agree to uphold my personal obligations. Limitation of Liability * Client agrees to indemnify, defend and hold Akasha Hines harmless from all claims, losses, judgments, damages, expenses and costs (including, without limitation, attorneys’ fees and court costs), whether fixed or contingent, and whether or not adjudicated, arising from or in any way related to: (a) the breach of any of its obligations hereunder; (b) damage to real or tangible personal property of the client or any third party as a result of the fault of the client and not due to the fault of Akasha Hines (c) bodily injury to any party caused by client and not caused by Akasha Hines; (d) any breach of representations or warranties regarding services of Akasha Hines made by clients or any other third party; (e) payment of services owed to the birthing facility (f) any unauthorized act or omission of the doulas; and (g) the negligence, recklessness or willful misconduct of Akasha Hines (h) the aforementioned exceptions of services, including but not limited to, medical monitoring, medical decisions, medical opinion, treatment options, physical services, and medical services. I understand and agree to the limitation of liability. Fee * A non-refundable deposit of 35% of the total balance will be due within one week of the signing of this contract. The remaining balance will be due by the 37-week point in your pregnancy. If circumstances are such that I cannot attend your birth, I will provide a qualified backup and I will be responsible for payment of her services. She will provide the services outlined in this contract. In the event of extraordinary circumstances or I have been with you for 24+ hours, I may request a backup doula to relieve me. My fee reserves your place in my calendar. Fees are non-refundable. In the event, you fail to call me to advise you are in labor or if you have a rapid birth that I am not in attendance for, I will provide a postpartum visit per our contract. Fees are not adjusted for length of time in labor or birth. Should fees not be paid in full as directed above, it is solely at my discretion to provide childcare during labor and birth, unless other arrangements have been made. I understand that the fee is outlined in the package that I chose and a non-refundable deposit of 35% is due upon signing this contract in order to reserve my birth. Name * First Name Last Name Email * Phone * (###) ### #### Estimated Due Date * MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Special Instructions or Gate Code Name of Partner or Other Authorized Persons who can contact us regarding your children. Please List Name and Phone Number Planned Place of Birth Address 1 Address 2 City State/Province Zip/Postal Code Country Children Names and Ages Are there any special considerations I should be aware of including dietary restrictions, allergies, medications, etc? Please be specific for each child. What activities would you like for your sibling doula to do with your child(ren)? Agreement and Signature * Please type in the space provided below: I, (your name), understand and agree to the obligations, scope of practice, limitation of liability, and fee as stated in the contract above. I can’t wait to work with you and support you throughout pregnancy and birth. I will be in touch shortly to set up our first prenatal appointment.Akasha Hines