Stroud Birth Pools Booking Form

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Please complete the following to request a birth pool

Email *

Name *

Phone number *

Due Date Estimated *

Please check date format carefully before entering!

YYYY

Pool size *

Please indicate if you would prefer a Mini pool, or a Regular Pool, or if either is fine.

The Mini pool is still suitable for women up to 6’ tall, but holds less water so might be preferable if you do not have a continuous hot water supply. The Regular pool is recommended for those over 6' tall, and if two people plan to get into the water.

Further details here: https://www.birthpoolinabox.co.uk/pages/size-guide

Mini

Regular

Either

Address *

Postcode *

Outside postcode return

I am aware that I will need to return the pool to Stroud at the end of my hire period. (If you live outside of GL5, GL6, GL10)

Yes

Agreement *

I agree to use the pool only as described on the Stroud Birth Pools website: https://stroudbirthpools.wixsite.com/home/how-the-scheme-works

I agree to have my email address and mobile phone number shared with other users of the Stroud Birth Pools loan scheme operated by Stroud Maternity Matters volunteers, for the duration for which it is appropriate to my use of the service.

Agree

Required

Info

Please include any additional information you feel may be relevant, such as previous early arrivals etc.

Send me a copy of my responses.

Submit

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