Thank you for taking the time to fill out this form. Having this information prior to our prenatal classes helps me to utilize our time together more effectively and serve you better. If you have any questions, please do not hesitate to ask.

Please note, this information is private and will not be shared with any parties with out your express consent. 

    Information about you

    ​Alternate/Additional Support Person (If you have one)

    Information about your Care Providers

    Information about your pregnancy + upcoming birth + postpartum

    Private Prenatal Class Terms and Conditions:

    OBJECTIVE My objective is to assist people in achieving a fulfilling experience in providing them with education, emotional support or other tools and resources to equip them through pregnancy, the labour and delivery process and postpartum.

    1. Services and Service Fees 
    1.1. Service. Under this Agreement, Samantha Gagnon agrees to provide in person prenatal education to you in exchange for the Program fee outlined in paragraphs 1.3 
    1.2. Term. The Term of this Agreement will commence upon your acceptance of this Agreement and payment of portion or all of the applicable Program fee as outlined in paragraphs 1.3 and 
    1.3 Fee. All payments shall be made in Canadian dollars.  
    1.4. You agree and understand that upon commencement of the Term of this Agreement, you  are enrolled in the Private Prenatal Class.
    1.5 No Refunds. Samantha Gagnon abides by a strict, no refund policy. By accepting  the terms of this Agreement, you agree and understand that you will not claim any refund of fees paid for access to services. 

    2. No Warranties 
    2.1 Success not Guaranteed. By accepting the terms of this Agreement, you agree and understand that Samantha Gagnon provides educational resources, information and suggestions only. Samantha Gagnon does not make any specific health claims or promise medical results and does not guarantee a problem-free or pain-free birth. 
    2.2 In the case where Samantha Gagnon is called to a live birth during a scheduled class, arrangements will be made to reschedule your class within 2 weeks.   


    3. Not A Substitute for Medical Advice 
    3.1 Not a Substitute for Medical Advice. Any documents, materials, information or suggestions given to you in connection to the service does not constitute medical advice, should not be construed as constituting medical advice and is not intended as a substitute for the medical advice of a properly licensed health care professional. You understand and agree that if you experience any adverse symptoms or pain it is your responsibility to consult a medical professional or to call 9-1-1.  

    4. Limits on the Scope of Services 
    4.1 Limits on the Scope of Services. You agree and understand that Samantha Gagnon does not do any of the following as part of the Program: 
    a. Perform clinical tasks, including but not limited to, taking blood pressure, fetal heart checks or vaginal exams;  
    b. Speak to medical staff or providers on your behalf; 
    c. Make healthcare or medical decisions for you;  
    d. Participate in the live birth in person with virtual or live classes, webinars or programs
    e. Provide medical advice. Samantha Gagnon can direct you to resources that might help you answer questions and make informed decisions on your own. If you have questions or want advice about your care or that of your baby, you should contact your health care provider. 

    5. Assumption of Risk 

    5.1 Assumption of Risk. You understand and agree that the use of any product, recipe, suggestion or recommendation discussed in connection with the service is at your own risk with no liability on the part of Samantha Gagnon. You agree to accept full responsibility for your use or non-use of any information provided to you by Samantha Gagnon.

    6. Limitation of Liability 
    6.1 Limitation of Liability. You agree, to the fullest extent permitted by law, to limit the liability  of Samantha Gagnon, whether arising from breach of contract, negligence, or other common law or statutory theory of recovery, so that the total aggregate liability of the Samantha Gagnon. shall not exceed the cost of the applicable Program fee. It is intended that this limitation apply to any and all liability or cause of action however alleged or arising, including but not limited to negligence, breach of contract, or any other claim whether in tort, contract or equity.  

    7. Indemnification 
    7.1 Indemnification. You will agree to indemnify and hold harmless Samantha Gagnon,  its agents and employees from any and all claims, actions, liabilities, injuries, damages, losses, costs, and expenses arising out of or in connection with any use of the Program by you.   


    8. Non-Disclosure and Privacy 

    8.1 Non-Disclosure. You agree that you shall not provide or make available publicly or to any  third-party any login credentials, video or audio communications or presentations, or any materials or documents you have obtained access to as part of your enrolment in the Service.   
    8.2 Privacy. Samantha Gagnon is committed to safeguarding your personal information that is collected as part of your enrolment and participation in the Service. Samantha Gagnon manages your personal information in accordance with British Columbia’s Personal Information Protection Act and other applicable laws and agrees to collect, use or disclose your personal information only as authorized by law.  

    9. Miscellaneous 
    9.1 Transferability. The rights and obligations under this Agreement are personal to you and  you may not assign or transfer any rights or obligations under this Agreement. 
    9.2 Integration. This Agreement represents the entire Agreement between you and Samantha Gagnon regarding the Service, and this Agreement supersedes and replaces any prior proposal, representation or understanding you may have had with Samantha Gagnon relating to classes, programs, or virtual training whether oral or written. 
    9.3 Governing Law. This Agreement shall be governed and interpreted in all respects in accordance with the laws of British Columbia, Canada. 
    9.4 Legal Counsel Fees. If any proceeding or action shall be brought to recover any amount  under this Agreement, or for or on account of any breach of, or to enforce or interpret any of the terms, covenants, or conditions of this Agreement, the prevailing party shall be entitled to recover from the other party, all reasonable legal counsel fees, disbursements and costs. 
    9.5 Severability. If a court of competent jurisdiction should determine that any provision of this  Agreement is void or unenforceable, such provision shall be deemed to be severable and such determination shall not affect the validity or enforceability of any other provision of this Agreement unless as a result of such determination this Agreement would fail of its essential purpose.