Birth Professionals: Course Enrollment and Release Agreements

Name(required)

Pronouns (He/She/They, etc.)

Email(required)

Phone Number

How did you hear about this class?

I understand that I am attending this HypnoBirthing® class series as an observer. The purpose is to gain an understanding of HypnoBirthing® to strengthen my knowledge and support of clients and families. Attendance of this HypnoBirthing® class does not grant the ability to teach HypnoBirthing® to expecting families or certify educators. (Birth professionals who would like the title "HypnoBirthing® Supportive Doula" may achieve this by attending the HypnoBirthing® Support Techniques For Birth Professionals Course. Birth professionals who would like to teach HypnoBirthing® to expecting families may achieve this by attending the HypnoBirthing® Educator Certification Course.) As an observer, I will respect the integrity and privacy of the families attending this HypnoBirthing® class series. I fully understand the contents, meaning, and impact of this agreement. YES or NO(required)

I grant permission to HypnoBirthing® International and its affiliate Portland HypnoBirthing® Center, to use photographs/and or video and audio taken of me. The images/video/audio/may be used for educational, teaching and promotional purposes only. I authorize HypnoBirthing® International and its affiliate Portland HypnoBirthing® Center to copyright, use and publish the same in print, video, and/or electronically. All educators given access to the images/video/audio have signed an agreement stating the above, and ensuring that no unauthorized content is uploaded to the internet or reproduced. I indemnify HypnoBirthing® International from any and all liability arising out of the use of the images/video/audio and waive any and all claims and causes of action relating to the use of the images/video/audio and waive any and all claims and causes of action relating to the use of the images/video/audio, including without limitation, claims for invasion of privacy rights or publicity. I am 18 years of age or older, am the parent of legal guardian of the minor in the images/video/audio. I have read this release before checking this box, fully understanding the contents, meaning, and impact of this release. YES or NO

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