Mom's Name *

First Name

Last Name

Partner's Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mom's Phone Number

(###)

###

####

Partner's Phone Number

(###)

###

####

Due Date

MM

DD

YYYY

Checkbox

Please check which services you are committing to:

Birth Doula

Birth Photography

Will this be your first child?

Yes

No

Are you open to getting pain medication/epidural?

Yes

No

Maybe

Are you planning to breastfeed?

Yes

No

Maybe

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.*

I agree

Today's Date

MM

DD

YYYY