Birth Pool Booking Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of person responsible for the equipment during the hire

First Name

Last Name

Location of Pool

Home ground floor

Upper floor in house

Other Location

Are you satisfied with the weight loading for your chosen pool location

Please tick

Yes

No

Is this your first baby

If applicable please tick

First

Second

Third

More than three babies

Have you used a pool before

Please tick

Yes

No

If applicable what was the location

Please tick

at home

in hospital

Other

COSTS

WE WILL EMAIL YOU TO CONFIRM YOUR BOOKING DETAILS AND SEND YOU PAYMENT OPTIONS

Birth Pool Hire fee - up to 4 weeks - £225

Optional extras

We supply 10 metres of new input hosepipe as standard - please let us know if you require more and this will be charged at £2.00 per metre.

Optional Disposable liner (personal preference, if in stock) £45

I will need additional input hose pipe (£2.00 per metre)

COLLECTION and DELIVERY options

Optional delivery and/or collecion is available at £47.50 standard for distances under 50 miles for one round trip - or at 48 pence per mile for further distances (round trips)

I will arrange collection myself

I will arrange return myself

Please deliver (charges apply)

Please collect (charges apply)

DAMAGE RETAINER DEPOSIT

I understand that it is required for me to lodge a 'refundable' £100 damage retainer as a separate payment to be held by Blue Lagoon during the hire period which will be returned to me when the equipment is returned to Blue Lagoon in good condition at the end of the hire. If paid by bank transfer we will require your bank details to facilitate a refund

RESERVATION

I wish to reserve a Blue Lagoon Pool for the hire period stated above and I will pay a £50 non-refundable deposit with the balance being due no later than two weeks prior to the commencement of the hire. If I am unable to complete my booking, Blue Lagoon will refund the balance of the hire fee paid, however no refunds will be given within 4 days of the hire starting date. All bookings made within two weeks of the hire start will need to be paid in full (refund pollicy will apply)

Important *

I am enquiring about/booking a pool having discussed my birth options with my Midwife, NHS professional or medical doctor