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Baby Massage Class Registration
Registration is for 1 baby and up to 2 caregivers.
Note: Registration for Baby Massage for Expecting Parents is for 2 caregivers.
Instructor: Nicole Lasley, LMT, CIMT, CPMT
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Email
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Your email
Baby's Name (First and Last)
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Your answer
Names of Caregivers Attending (Registration includes up to 2 caregivers)
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Your answer
Baby's Date of Birth
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Your answer
Full Address
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Your answer
Phone Number
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Your answer
Course(s) Attending:
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Baby Massage for Teething and Congestion (10:00 AM on Feb. 29, 2023)- $35
Required
Did mother/baby experience and complications with pregnancy or birth?
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Yes
No
Have not delivered, yet
If yes, please explain.
Your answer
Does baby have any health concerns, high risk factors or diagnoses (currently or in the past)?
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Yes
No
Have not delivered, yet
If yes, please explain.
Your answer
Pediatrician
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Your answer
In Case of Emergency Contact (Name and Phone Number)
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Your answer
What are you hoping to learn in this class?
Your answer
Is there anything else your instructor should know about you or your child?
Your answer
Next, you will be taken to the payment page. Please note that your registration is NOT complete until you have paid in full, and your spot will not be reserved until then.
All sales are final. I do not offer refunds if you are unable to attend. However, should you decide you'd like to transfer your registration to someone else, you may do so with advanced notice (minimum of 72 hours in advance), by contacting Dot to Dot Massage at 423-615-9893.
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A copy of your responses will be emailed to the address you provided.
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