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Private Membership Association

Carolina Birth Center, DBA Carolina WaterBirth

(A Private Membership Association)


By purchasing/enrolling, I do hereby apply for and/or accept membership in Carolina Birth Center PMA (CBC), a Private Membership Association.   Carolina WaterBirth is the most recognized name of this PMA because it existed prior to CBC and is associated with home birth whereas CBC is limited to birth center services.  By scheduling/enrolling I am affirming that I have read and agree to this membership agreement and that I/we accept the offer made to become a member of CBC and have read and agree with the following Declaration of Purpose


1. This Association of members hereby declares that I/we wish to accept services in affirmation of CBC’s objective to be a source of information, support and care for women and newborns in a healthy environment that respects the process of birth as a divine step into parenthood.  That parents, family and midwives are tasks with the protection of the birthing process in an effort to enhance the pursuit of happiness and to build strong foundations for future generations. 


2. Additionally, we strive to maintain and improve our civil rights, constitutional guarantees, and political freedom of every member.   

3. As members, we have faith in natural processes.  We affirm our belief that birth choices and parenting are rights and responsibilities given by our creator and that these decisions should be made by the parents that have been blessed with their own pregnancy.   We believe that the First Amendment of the Constitution of the united States of America guarantees mankind the rights of free speech, petition, assembly, and the right to gather together for the lawful purpose of advising and helping one another in asserting our rights.


IT IS HEREBY Declared that we are exercising our right of freedom of association as guaranteed by the 1st and 14th Amendments of the American Constitution and equivalent provisions of the various State Constitutions. This means that our association activities are restricted to the private domain only.


The Association will recognize any person (irrespective of race, color, or religion) who is in accordance with these principles and policies as a member, and will provide a medium through which its individual members may associate for actuating and bringing to fruition the purposes heretofore declared.




I understand that the fellow members of the Association that provide services and care, do so in the capacity of a fellow member and not in the capacity as a licensed health care provider. I further understand that within the association no doctor/midwife-patient relationship exists but only a contract member-member Association relationship. In addition, I have freely chosen to change my legal status as a public patient, customer or client to a private member of CBC. I further understand that it is entirely my own responsibility to consider the advice and recommendations offered to me by my fellow members and to educate myself as to the efficacy, risks, and desirability of same and the acceptance of the offered or recommended diagnosis, therapy, treatment and care is my own carefully considered decision. Any request by me to a fellow member to assist me or provide me with the aforementioned diagnosis, therapy, treatment and care is my own free decision in an exercise of my rights and made by me for my benefit, and I agree to hold the Trustee(s), staff and other worker members and the Association harmless from any unintentional liability for the results of such care, except for harm that results from instances of a clear and present danger of substantive evil as determined by the Association, as stated and defined by the United States Supreme Court.


Cynthia Jane Glenn ™ is the member chosen as best qualified to perform services to members of the Association and she is entrusted to select other members to assist her in carrying out that service.


In addition, I understand that, since the Association is protected by the First and Fourteenth Amendments to the U.S. Constitution, it is outside the jurisdiction and authority of Federal and State Agencies and Authorities concerning any and all complaints or grievances against the Association, any Trustee(s), members or other staff persons. All rights of complaints or grievances will be settled by an Association Committee and will be waived by the member for the benefit of the Association and its members. Because the privacy and security of membership records maintained within the Association which have been held to be inviolate by the U.S. Supreme Court, the undersigned member waives HIPAA privacy rights and complaint process. Any medical or healthcare records kept by the association will be strictly protected and only released upon written request of the member. I agree that violation of any waivers in this membership contract will result in a no contest legal proceeding against me. 

The first dollar from each member for services after organization of this PMA is considered payment for membership and membership shall continue until such time as member request removal.  This understanding agreement shall be posted on our services website and all initial services may be paid on the website where this statement remains public.  Membership includes the ability to schedule standard appointments online from the comfort of home.


I understand that the midwives, nurses, doctors, doulas and other providers who are fellow members of the Association are offering me advice, services, and benefits that do not necessarily conform to conventional medical care. I do not expect these benefits to include on-call coverage, hospital care, or the usual and customary care provided by most physicians. I will receive such primary and specialist care elsewhere. I fully understand that the benefits I receive from the Association might or might not be covered by my health insurance.


As a member, I accept the goals of helping my body function better and choosing techniques that are both very safe and have a reasonably good chance to succeed, realizing that no diagnostic technique or treatment is foolproof. If I choose to forgo drugs, surgery, or medications that may have been recommended to me by others, I fully accept the risk that I might suffer serious consequences from that choice. Other aspects of informed consent will take place in my discussions with the providers and my fellow members of the Association.


My activities within the Association are a private matter that I refuse to share with the State Medical Board, the FDA, FTC, Medicare, Medicaid, Department of Health or my own insurance company without my expressed specific permission. All records and documents remain as property of the Association, even if I receive a copy of them. I fully agree not to file a malpractice lawsuit against a fellow member of the Association, unless that member has exposed me to a clear and present danger of substantive evil. I acknowledge that the members of the Association are not required to carry malpractice insurance.


I enter into this agreement of my own free will or on behalf of my dependent without any pressure or promise of cure. I affirm that I do not represent any State or Federal agency whose purpose is to regulate and approve products. I have read and understood this document, and my questions have been answered fully to my satisfaction. I understand that I can withdraw from this agreement and terminate my membership in this association at any time. These pages and Article I of the articles of association of the Association consist of the entire agreement for my membership in the Association and they supersede any previous agreement.


I understand that the membership gives me access to products and services that will require a fee to receive said products and services. I agree to pay said fees to receive said products and services.


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