Today's Date
              
             
          
                
                
                  
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              Due Date
              
             
          
                
                
                  
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              Mom's Name
              
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                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Dad's Name
              
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              Address
              
             
          
                
                
                  
                    Address 1 
                   
                
                
                  
                    Address 2 
                   
                
                
                  
                    City 
                   
                
                
                  
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              Email Address
              
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              Mom's Phone
              
             
          
                
                
                
                  
                    (###) 
                   
                
                
                  
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              Dad's Phone
              
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                    (###) 
                   
                
                
                  
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              Emergency Contact Name
              
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                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Emergency Contact relationship to clients
              
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                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Emergency Number (other than mom or dad)
              
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                Someone close to mom and dad who can give photographer status updates
                
                
                  
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              Planned place for birth
              
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                    Hospital 
                  
                    Birthing Center 
                  
                    Home 
                  
                    Other 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Name of Birth Location 
              
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              Address of Birth Location
              
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                    Address 1 
                   
                
                
                  
                    Address 2 
                   
                
                
                  
                    City 
                   
                
                
                  
                    State/Province 
                   
                
                
                  
                    Zip/Postal Code 
                   
                
                
                  
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              Is this your first birth?
              
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                    Yes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Birth Plan
              
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                    Spontaneous Birth 
                  
                    Scheduled Induction 
                  
                    Scheduled Cesarean Section 
                  
                    Unsure 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Have you obtained permission from your OB  AND HOSPITAL  to have a photographer in the birthing room?
              
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                    Yes 
                  
                    Not Yet 
                  
                    Not Applicable 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              In the event of a c-section, has your OB AND HOSPITAL given you permission to have a photographer present in the operating room?
              
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                    Yes 
                  
                    No 
                  
                    Not Yet 
                  
                    Not Applicable 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              Name other individuals who will be in the birth room with you (including partner, if applicable)
              
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              4. LIMIT OF LIABILITY: In the unlikely event that the photographer is injured or becomes too ill, or has an extreme emergency that prevents her from photographing the agreed upon session, responsibility and liability is limited to the transfer of deposits made to the session types of Fresh 48 and Newborn Session rather than birth. Due to the nature and timing of birth being unpredictable, Tori J Cox Photography cannot be held accountable or liable for a missed birth. Tori J Cox Photography takes the utmost care with respect to exposure, transportation, and processing the photographs. However, in the unlikely event that photographs have been lost, stolen, or destroyed for reasons within or beyond Tori J Cox Photography's control, Tori J Cox Photography's liability is limited to the return of all payments received for the portrait package.  *If we cannot provide coverage as a result of client's actions or due to circumstances beyond anyone's control, all fees paid will be applied toward a Fresh 48 and Newborn Session. 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.*
              
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                By typing your name below, you agree to the above
                 
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              IMPORTANT INFORMATION! Thank you for inviting me to photograph your upcoming birth experience. Since births are a bit different than a standard session, here are some guidelines to insure I can give you the best experience possible. Please read and then provide your signature below. Be sure to print a copy for yourself as well.   Planned vaginal delivery or scheduled induction of labor:  I will be on call for your birth 24/7 from 39 weeks through 41 weeks gestation. If your doctor or midwife schedules an induction or planned cesarean for you, please let me know immediately so I can plan that date accordingly. Please keep me updated via telephone or text when you leave for the hospital and upon admission. Dad should keep me updated via text. My cell number is 940-390-7148. Please store this number in mom and dad's phones well in advance. My goal is to be at your place of delivery or labor before mom hits the point where she can no longer speak on the phone. If you are being checked for dilation, please keep me posted with your progress at each check. I plan to arrive when you are 6-7cm dilated, depending on how rapidly your birth is progressing. Please note that it takes me approximately 1 hour to arrive at the birth location from your initial phone call to being by your side. I will stay with you through the rest of your labor/birth, and 1 hour post birth to document weight, footprints, family/baby interaction, etc.     Please contact me as soon as you *think* you might be in labor so I can begin making plans to be there.  Even if it’s 2 a.m. Even if it’s a false alarm! I would 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 me know how things are progressing and/or if there will be any changes to your initial birth plan. A quick text is fine!    Scheduled Cesarean Section:  I will provide coverage 1 1/2 hours prior to, during (if permission is granted), and post-delivery. Images will be provided in a documentary fashion, documenting your experience as much as possible, as well as documenting your baby's first moments.
              
             
          
                By signing the below you understand/agree to the above