Birth Plan/Fresh 48 + Contract

Birth Photography Contract

Everyone has a different ides of what they want when it comes to their birth plan. What's important to you? What do you want focused on? Please fill this out to give me the best idea of your birth story, and what you expect from me while documenting it.
What type of session: *

Birth Fresh 48
Client Information
Mom's Name *

First Name Last Name
Birth Partner's Name

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Cell Number *

Area Code Phone Number
Birth Partner's Cell Number *

Area Code Phone Number
Emergency Contact *

First Name Last Name
Relationship to Emergency Contact *
Emergency Contact # *

Area Code Phone Number
Birth Information
Estimated Due Date *

Month Day Year
If this is not your first labor, how would you describe your previous labor and deliveries? (Check all that apply.) *

Within 1 Week of EDD Within a few days of EDD 2+ weeks past EDD Quick Even Pace Slow Natural Induction Scheduled C-Section Emergency C-Section This is my first labor
If you would like to elaborate on any answers above, please do so here:
Current Pregnancy *

Normal With No Complications Some Complications, No Concern as of Now High Risk
Which birth package did you want to choose: *

Heirloom Keepsake Essence
What type of coverage is most important to you? *

Photos Video Mixture of Both
Doctor's Name *
Doctor's Phone Number
Birth Location *

Hospital Birth Center Home
Name of Birth Location *
Birth Location Address; please note any locations over a 30 miles radius are subject to a travel fee to be added to your final invoice *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Your Birth Plan
Labor Method (choose all that apply) *

All Natural Medicated Planned C-Section
Unmedicated Techniques for Pain Relief

Massage/Pressure Shower/Bath Rebozo Hot/Cold Packs Hypnobirthing TENS Machine Acupressure Nipple/Genital Stimulation
Techniques for Pain Relief: *

None Gas & Air Pethidine Epidural (anaesthesia) Spinal Block (caesarean section only)
What do I want my birth environment to look like? *

Music Low Lighting Aromatherapy Affirmation Cards Own Clothing Hospital Gown
Please note, if you are choosing to labor with minimal lighting it can affect the quality of footage. I will always do my best to improvise where I can (including using off camera flash pointed at the ceiling), however, the less amount of light the more grainy your footage will be. *

I understand; I want you to make any adjustments to make sure the lighting is ideal for pictures/video. I understand; I'm planning to have minimal lighting and I'm okay if the footage is more grainy.
What birthing aids would I like to use? *

Peanut Ball Fit Ball Birthing Stool Beanbag Squatting Bar Birth Pool None
Mobility: *

Prefer to stay in one position Prefer to move about during labor
Positions: *

Walking Squatting Kneeling Standing Sitting Lying Down
Fetal Monitoring *

Continuous Monitoring Intermittent Monitoring Doppler Monitoring
Please be aware that high risk pregnancies, induction and epidural use births are likely to have continuous monitoring for the safety of baby.
Delivery: *

I want to feel my babies head I want to have a mirror to see the pushing and crowning stages I want to catch my baby I want my partner/support person to catch my baby
Caesarean Birth

Spinal Block General Anaesthesia Partner/Support Person Present Lowering of drape for the birth Clear Drape Describe the procedure as it occurs Pull own baby from stomach
Following Birth *

Immediate Skin to Skin Delayed Cord Clamping I want to cut the cord I want my partner to cut the cord I want selected support person to cut the cord: _________________________ I agree to an injection to speed up placenta delivery I disagree to an injection to speed up placenta delivery I want to donate my placenta to science I want my placenta to be encapsulated I want to take my placenta home I want the hospital to dispose of my placenta
Feeding *

Exclusively Breastfeeding Exclusively Pumping Mixed Feeding Exclusively Formula I agree to my child being given a pacifier I disagree with my child being given a pacifier
In the event of a C-section, have you spoken with your doctor about allowing photography in the OR? *

They said Yes They said No They said Maybe (this usually means no.) We haven't spoken to them
Will you have a doula or other support team member present? *

Yes No
Is there any time that you would like me to leave the room during particular situations or procedures? *

Internal Examinations Catheter Insertion/Removal Epidural Emergency Situation
Who else will be in the room (besides medical staff) as you are giving birth? *

Spouse/Partner Child(ren) Friend Doula
Anything else you would like us to know about your birth plan, labor plans, doctor, hospital, etc. *
With a booked birth session you are eligible to receive -

$100 off a fresh 48 session, would you like to add this to your package for $300 ($400 value)? $50 off an Essence maternity session, would you like to add this to your package for $200 ($250 value)? None, thank you.
Birth Videography Model Release Form

I hereby assign full copyright of all photo + video footage to the above-mentioned videographer Shannon Burke Photography with the right of reproduction.
I grant the Videographer the exclusive and perpetual right to take, use, and publish this footage, which contains client’s image in accordance to these permissions: *

Any footage during the client’s birth story Majority of footage, excluding clips with nudity below the waistline (to include crowning images) Majority of footage, excluding ciples with nudity below the waistline AND nudity above the waistline (to include nipples) No footage unless explicitly approved by client in writing (email or text message is sufficient)
I grant the Videographer (Shannon Burke Pohotgraphy) the perpetual and irrevocable and unrestricted right to use and publish video and/or photographs that meet the above criteria on: *

Website Blog Social Media (including Facebook and Instagram) Print advertising Promotional material
I undertake not to prosecute or to institute proceedings, claims or demands against the Videographer in respect of any usage of the above mentioned photographs. I hereby release the Videographer from all claims and liability relating to video or photographs taken of me.

I have read this model release form carefully and fully understand its meanings and implications.

Client agrees that the footage and final video created by Shannon Burke Photography are the exclusive property of the Videographer, and the client will retain no commercial rights to the footage or video.

Client agrees that he/she is the parent or legal guardian of the minor child and has full rights and authority to grant consent.

In the event a back-up videographer is used, back-up videographer will surrender all footage to Shannon Burke Photography and the above items will be instituted accordingly.
Contract
I will be on call for your birth 24/7 from 37 weeks to 42 weeks gestation. Please keep me updated via telephone or text when you leave for the hospital and upon admission. I will arrive when you are approximately 6 cm dilated, depending on how rapid your labor is progressing. Please note that if you are in the Scottsdale or Peoria area, it takes me approximately 30 minutes to arrive at the hospital from phone call to being by your side. If you are in Gilbert, Mesa, or Chandler, it will take roughly 1 hour.
Please contact us as soon as you *think* you might be in labor so we can begin making plans to be there. Even if it’s 2 a.m. Even if it’s a false alarm, we’d much rather be ready to roll than to miss the event! It is also helpful for us if you check in after doctor’s appointments in the weeks before labor and let us know how things are progressing and/or if there will be any changes to your initial birth plan *

I agree
I need ONE HOUR from "come now!" to my arrival. If your baby is born in under an hour from when you ask me to come, I'm not responsible for missing the birth. Please call me when you are in active labor. If you need help determining this, your midwife or nurse will be able to help you. You're also welcome to text me with your contraction pattern, and we can determine the right time together.
Due to the nature and timing of birth being unpredictable, we cannot guarantee that we will be able to make the birth. If I cannot make it (due to unforeseen reasons such as illness, car trouble, etc.) A backup photographer will be provided. Please know that I will make every effort to make it to such a special time, but things do happen. If we cannot provide coverage as a result of your actions or due to circumstances beyond anyone's control all monies paid will be applied towards an alternative session (Fresh 48, Newborn, etc.). Examples of this include, but are not limited to: failure to provide adequate notice of the baby's birth; an unexpected transport for a c-section; a dramatic change in the birth plan. In instances like this, beyond our control, no refunds will be given. If you decide to cancel our services for any reason, please let us know at least 30 days before your due date. Your initial retainer is non-refundable. *

I agree
The videographer holds copyright for all images and footage taken during the Birth Session. Any attempt to claim the finished film as client’s own will result in lawful action. Birth films are for personal use only. Videographer obtains the irrevocable right to utilize clips from your Birth Session for advertising or commercial purposes. This includes the posting of your film on advertising materials that include photographer’s website and Facebook page in accordance to model release (See Model Release) We reserve the right to use any image for display, publication, or other purposes; however, we will honor any requests by the family for using, or not using, certain images when necessary. With this birth package you will receive a release agreement that allows you to reprint any images for personal use. You may not sell these images or use them for any commercial use without the written approval of the photographer. Due to the intimate nature of birth photography, I will only publicly share images once you have EXPRESSLY APPROVED THEM. *

I agree
Videographer is not liable for any dissatisfaction of the final product as long as it represents videographer’s style and work in her portfolio. Client is responsible for viewing videographer website and portfolio. Upon signing this contract, client agrees that videographer’s style and quality of films is acceptable. *

Agree
It is the client’s responsibility to ensure place of birth (hospital, birth center or homebirth midwife) is aware of the birth videographer and doesn’t have guidelines against birth videography. Videographer is not responsible if she is not allowed to film certain parts of client’s birth story and contract is still fully enforceable. If the client has a C-section or is an emergency situation, it is client’s responsibility to discuss videographer’s presence in the operating room(OR). If photographer is not allowed in the OR, contract is still fully enforceable. Videographer will document client’s story from the vantage point that she’s allowed by hospital staff, staying longer if necessary to ensure she obtains enough images. In the event that videographer cannot obtain any footage due to an unusual medical emergency, a substitute fresh 48 or newborn film session may be offered. *

Agree
Videographer is hired as sole photographer. Client’s family and friends can also take photos and footage, but videographer is not responsible for missed shots due to interference. *

Agree
Is there anything else that would be helpful for me to know?
SESSION RETAINER AND PAYMENT: The Client shall make a non-refundable retainer in the amount of $250.00 for the Photographer to perform the services specified herein. Upon payment, Photographer will reserve the time and date agreed upon by both parties. Payment for product orders shall be submitted to Photographer on the day of placing product orders. Any payment plan agreements agreed to by Photographer and Client shall be included as an addendum to this agreement. No products shall be delivered until the entire amount is paid in full. In the event of an emergency/fetal demise, act of god, or situation beyond the photographers control all monies paid are nonrefundable. Balance may be transferred to a studio credit up to the photographers discretion. Any locations over a 30 miles radius from SBP are subject to a travel fee of $1/mile.

RESCHEDULING:  In the event that the Client requests to reschedule a photographic event, the retainer shall be applied to a rescheduled event if notice is given at least 14 days prior to the schedule event. Reschedule must be within the same calendar year. If the Client wishes to reschedule any time after the 14 days, the Client retainer will be forfeited and will not be applied to rescheduled event. Any Client that is late arriving to the session will have the amount of time late deducted from the time allotted for the session. Clients shall not be compensated for the time deducted from the session due to late arrival of the Client. In the event that the session requires travel and the Client is over 30 minutes late arriving to the session, Client will be responsible for paying a late fee of $75. Photographer maintains the right to reschedule if needed due to inclement weather, illness, emergency, etc. at no additional costs to the Client.

CANCELLATIONS:  If Client requests to amend or cancel this agreement 14 or more calendar days before the agreed upon photographic event date, the retainer shall be forfeited and the Client will not be responsible for the remaining balance. If Client cancels, or fails to show, this agreement 13 or less calendar days before the agreed upon photographic event date, the retainer shall be forfeited and the Client will be charged for the remaining balance in full.

COMPLETION SCHEDULE: Completion schedules and delivery of products shall be determined from date of photographic event. Third-party manufacturing laboratories are utilized for products and may provide restrictions on an order not outlined in this agreement.

• Digital Images shall take 2-3 weeks from date of photographic event to be processed and delivered via online gallery to Client.

• Albums shall take 7-14 days from date of album order to be received by the Photographer.

Client should place orders with sufficient time to allow for normal delays and notify Photographer at the time of the order if there are any extenuating circumstances requiring a quicker turn around. An expedited fee of $15 or more shall be applied to expedited product requests. The Photographer shall not be held responsible for delivery delays due to the fault of manufacturing and/or delivery services.

USE OF INDEPENDENT CONTRACTOR:  In the event a Photographer furnishes a hair and/or makeup artist, the Photographer is not liable for any application or services by this independent contractor. This includes but is not limited to allergies as a result of use of the products by the Independent Contractor. It is the Client’s responsibility to convey all allergies to the Independent Contractor.

ARTISTIC RIGHTS:  The Photographer retains the right of discretion in selecting the photographic materials released to the client. The Client shall receive a private online gallery of digital photographs and shall not receive any photographic materials not presented to the Client. The Photographer also retains the right to make adjustments to the photographs in post-processing as the Photographer deems within their creative control. Any images not found in the web gallery were not found satisfactory for release.

BODY ALTERATIONS: The Photographer retains the right to cancel the session and retain the retainer amount if the Client has engaged in any body alterations within two weeks of the session. Body alterations are including, but not limited to, self-tanning (spray, bed, etc.), tattoos, piercings, surgeries, etc..

COPYRIGHT AND REPRODUCTION:  Except as otherwise specifically provided herein, all photographs and rights therein, including copyright, remain the sole and exclusive property of Photographer. The Photographer shall have the exclusive right to make reproductions for, including but not limited to, marketing materials, portfolio entries, sample products, editorial submissions and use, or for display within or on the Photographer’s website and/or studio. If the Photographer desires to make other uses, the Photographer shall not do so without first obtaining the written permission of the Client. It is understood that any duplication or alteration of original images is strictly prohibited {Copyright Law Title 17, Appendix V. Additional Provisions of theDigital Millennium Copyright Act 2005, Section 102} without the written permission of the Photographer. Alterations include, but are not limited to, application of filters, cropping, or modifications of any kind.

CLIENT USAGE:  The Client shall only use the photographic materials, including digital files, in accordance with the permissions within this agreement. The Client’s photographic materials are for personal use only and shall not be submitted to contests, reproduced for commercial use. Further, the Client shall not authorize reproductions by non-purchasers covered within this agreement. Additional prints and/or digital files may be purchased between third parties and the Photographer with the permission of the Client. Accordingly, if the Photographer provides a digital file print release, the Client must act in accordance with the release.

SOCIAL MEDIA: This applies to all social media including Facebook, Instagram, Blogs, Etc. The Client may share web/blog post links and social media albums through use of the share functions and dissemination of direct links. Client shall not copy, screen shot, or capture the photographs in any other fashion. The Client agrees that they will under no circumstance alter the photographer's photographs which includes cropping, alteration in color, application of filters or modification of any kind. When published online it is required that citation of the photographer be made.

FAILURE TO PERFORM:  If the Photographer is unable to perform this agreement due to illness, emergency, fire, casualty, strike, act of God, pandemic/epidemic, or any causes beyond the control of the Photographer, the Photographer and Client shall make every attempt to reschedule the session. If a reschedule is unable to be performed, all monies paid are nonrefundable and monies will be applied in store credit for another session to be determined by the client.
SBP is not responsible for any images lost due to SD card malfunction or hard drive failure. In the rare event that this should happen, a reshoot will be offered. If a reshoot is not possible (birth/fresh 48) an alternative option will be given. *

Agree
Signature *

Clear
Please know this is YOUR birth, it's okay to speak up to what's important to you. If it doesn't feel right, say it. Also, every birth has the potential to end in a c-section, in the event that happens it's your decision on who you want in the room. Some hospitals allow photographers, some do not. But, you'll have a better chance of getting me in the OR with you if you and your spouse fight for it. You advocate for me, I'll advocate for you so you get what you want from your birth story. *

Agree
For the remaining balance on your session, how do you prefer to pay? *

Emailed Invoice Venmo Zelle Apple Pay
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Birth Photography Contract

Client Information

Birth Information

Your Birth Plan

Birth Videography Model Release Form

Contract