Client Agreement
For all clients attending The C alm Birth School classes, please complete
this form and return it to your instructor before comencing the classes.
I,
, hereby state that I am registering
attendance of The Calm Birth School classes of my own free will and have full
understanding of the following:
•
That The C alm Birth School has been designed to teach me to use my own natural
abilities to bring my mind and my body into a state of relaxation.
•
That The C alm Birth School Instructor will utilize and teach a variety of techniques
for the purposes of enhancing physical and emotional relaxation and to build
confidence for my baby’s upcoming birth.
•
That my success depends greatly on my own ability and desire to practice what is
taught during classes.
•
That I have other choices from which to seek antenatal education, and I have
chosen The C alm Birth School classes at this time.
•
That the content of these classes is in no way intended to be represented as medical
advice nor as a prescription for medical procedure. I am aware that I should seek
the advice of a medical doctor to answer any health -related issues, questions or
concerns that I may have surround ing my pregnancy, my labour or the delivery of
my baby.
•
I certify that I am in good health, both physically and mentally and that there are
no health related problems or reasons why I should not participate in The Calm
Birth School classes.
I therefore agree that I will in no way hold The Calm Birth School Instructor providing
these classes, The Calm Birth School, its Directors or representatives, responsible for
any special circumstances that could arise as a result of my pregnancy, my labour, or
the delivery of my baby; and I agree that neither I nor any member of my family will
mak e any claim or initiate any suit against them now or at any time in the future.
I understand and sign this document under my own free will.
S ignature of C lient:
________________________________________
Date: _______________________________________
S ignature of witness:
________________________________________
Date: _______________________________________