Client Commitment Form: Birth Doula

Mom's Name *
Mom's Name
Partner's Name
Partner's Name
Home Address
Home Address
Mom's Phone Number
Mom's Phone Number
Partner's Phone Number
Partner's Phone Number
Due Date
Due Date
Checkbox
Please check which services you are committing to:
Will this be your first child?
Please explain (if necessary)
Please describe the kind of birth you are hoping to have.
Are you open to getting pain medication/epidural?
Are you planning to breastfeed?
Photo Release
I grant to Sacred Spaces Photography, its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize Sacred Spaces Photography, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Sacred Spaces Photography may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I also understand that I am not permitted to sell or share these photos to publications or magazines without written consent from Sacred Spaces Photography. As a photographer of intimate moments, Sacred Spaces will seek personal permission to share any photos of breastfeeding or birth. *Please inform me if you would NOT like for your photos to be shared on social media platforms.*
Please enter the price we discussed for doula/birth photography services. A $150 deposit will be required now by cash, check, or Paypal. Sales tax will be added to all photography services. Doula Fee: $850 Doula + Birth Photography: $1400 Whole Kit and Caboodle: $2000
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Please see the information at the bottom of this form to find out more about purposeful giving.
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Today's Date
Today's Date
Sometimes birth is unpredictable. I can never guarantee an outcome, but I will do everything I can to help you reach your goals and capture the moments along the way. If I am unable to attend your birth because of my own error, you will receive a full refund. If I am unable to attend your birth because of something beyond our control (very quick labor, emergency situation), I will refund everything except the deposit. If I am unable to attend your labor because of your error (you didn’t call me), the full amount will still be due. In all births, I will discuss my schedule with you. If I am unable to attend your birth, I will have a back-up doula available. I will not have a backup for photography services. By typing my name below, I agree to the above terms and to present payment when required.

Purposeful Giving Program

I am intentional about making my prices affordable for families in this area. I never want money to be an issue for those who feel that they need a doula or would like memories captured through photography. If you are in financial need and unable to pay the standard fee, please feel free to contact me and we will work something out. 

If you are a family that can pay more or would like to add an extra $50-$100 to your fee to help sponsor another family in need, I would be happy to use those funds to help cover the expenses of their doula services/photography services.