Better Bonding: intro to infant massage

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REGISTRATION FORM: 4-week GROUP series
October 17-November 7 | 9:30-11am
Sunlit Valley, Sydney

Email *

The series will run Mondays from October 17 to November 7, from 9:30-11am. There will be a makeup date of November 14 should a class need to be rescheduled. Please confirm that these dates/times work for you before proceeding.

Yes

Please list your full name and personal pronouns: *

Another caregiver of your child is welcome to attend any sessions and learn with you. If applicable, please list their name/relation/pronouns, if relevant:

What is the best phone number to contact you?

How would you like to communicate following this form?

Phone/text

E-mail

Social media (if we are connected)

Clear selection

Where in the CBRM do you live? *

What is your baby's name? *

What is your baby's birthdate? Babies should be between 6 weeks (corrected) and pre-crawling at the series start to best benefit from the course. *

YYYY

Do you have other children? If yes, please list their ages. This is so I know to highlight ways siblings can be involved that are age-appropriate.

1-2

2-4

4-6

Clear selection

Does your baby have any of the diagnosed medical conditions listed below? If yes, please outline in the next section and I will be in touch regarding adaptations/suitability. While infant massage is not therapeutic massage, it is always recommended that you ask your doctor if introducing it is right for your baby if they have certain medical conditions. Other temporary conditions or illnesses may make infant massage inadvisable briefly and will be discussed further in class.

RE: above question

Does your baby have any known allergies? Food-grade oil (organic sunflower) is included for in-class and at-home use for local registrations, and is extremely safe to use. Alternatives can be advised or provided upon request if you are concerned, or you can dry massage.

Is there anything else about the pregnancy/birth, you, or your child that I should know about to better meet your family's needs and expectations?

There will be a private Facebook group for cohort class members. Do I have your consent to add you to this group via e-mail invitation? *

Yes

Maybe later

During our sessions, I sometimes take pictures of the group practicing. Do I have your consent to take and possibly share these photos?

Yes, I am comfortable with photos and sharing

I would like to see/approve the photos before they are shared

No, I would not like to be included in shared photos

Clear selection

How did you hear about this course and/or Belle Vie Birth & Baby? This helps me to understand how I'm best reaching clients. *

Recommended by a friend

Saw a print poster

Saw a post on Facebook

Saw a post on Instagram

Found via web search

Returing customer/client

Other:

How will you be paying for the course? The $80 fee is required in full to confirm/hold your spot, unless otherwise requested. Thank you! *

Pay now to officially hold spot officially (EMT: belleviebirthandbaby@gmail.com)

Payment is partially/fully covered (by a promo/gift certificate/other (I will reach out)

Would like to discuss flexible payment options, such as a payment plan (I will reach out)

Required

THANK YOU! Do you have any questions you would like answered when I reach out to confirm your registration?

Send me a copy of my responses.

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