Text Box: For no unexpected surprises for parents to be (except maybe twins!) - below is a copy of the service contract between service provider (naMAMAste / Emily Canibano) and client (you!) Text Box: naMaMaste Service Agreement I _______________________________ on this day ____________agree to pay Emily Canibano, of naMAMASte, for doula services as described under the _______ plan, at rates described in Addendum A. I understand that a deposit of $_______ is required at the signing of this contract to reserve naMAMAste doula services for my birth month. The remaining balance $________ will be due at week 38 of my pregnancy. For any additional services rendered such as, but not limited to: yoga, fitness, belly casting, henna, photography, payment will be due at the time of service. I further understand that: • In the event unforeseen circumstances arise, and Emily Canibano is unable to attend my birth, a back up doula will be provided in advance of my scheduled due date. The back up birth doula will not charge extra fees for her services. Emily Canibano is responsible for providing compensation to the back up birth doula. • For reasons beyond my control or the control of Emily Canibano, or a back up birth doula, such as extreme illness, medical emergency, or an act of nature, resulting in the non attendance of Emily Canibano or a backup birth doula during my birth, I will receive a full refund, less the amount subtracted for all services previously rendered. • If I elect to not contact Emily Canibano at the onset of my labor, or the birth is other than my ideal experience, or I have an emergency cesarean surgery, or situations present where hospital protocols prohibit Emily Canibano, or a back up birth doula to be present during my birth, I agree to make payment in full to Emily Canibano. I acknowledge that I have received, reviewed, understood, and agree to the above terms of the service agreement / contract and Addendum A. _______________ _____________________________________________ Date Signature _______________ _____________________________________________ Doula Witness Print Name naMAMAste Addendum A Service Plans and Fee Schedules Premiere Prenatal Plan $1000 : • 8 one hour Prenatal or Postnatal Yoga / Fitness Instruction within the ACOG Guidelines (can be split pre and post) • 4 one hour Prenatal Visits which include Childbirth Education Discussions • On Call 24-hrs per day 2 Weeks Prior to Due Date • 24 Continuous Hours of Labor Support (in hospital or at home) • 4 hours of Post-partum visits up to 2 weeks post-partum • Digital Hospital / Birth Photos if desired* (provided at no extra cost digitally) Prix Fixe Prenatal Plan: $175 minimum, additional services and hours are extra • Labor Support $150 minimum (covers up to first 4 hours) • Required 1 hour prenatal visit $25 (prior to labor & delivery) Other services: • Belly Henna $25 a design • Belly Casting $40 per cast (sanded and smoothed, unfinished) • Photography o digital free with birth support o film based cost of film and developing • Prenatal Fitness / Yoga Instruction *$50 per hour o 1 additional friend no extra cost o $10 per person additional charge • Prenatal Visits $25 per hour • Post-Partum Visits $40 per hour • Labor Support / Birth Doula Schedule of Fees o $15 per hour (hours 5-15) o $10 per hour (hour 16 and on +) I acknowledge I have received, reviewed, understand, and agree to the above terms and schedule of fees. ___________________ ___________________________________________ Date Signature ____________________ _________________________________________ Doula Witness Print Name