Patta Cake Parent & Baby Wellbeing Class Registration Form

Please NOTE...
THIS FORM DOES NOT GUARANTEE YOUR SPACE ON ANY CLASS, IT IS PURELY A HEALTH FORM TO GO ALONGSIDE YOUR ACTUAL BOOKING. PAYMENT MUST BE MADE IN FULL AT THE TIME OF BOOKING

Baby Massage is suitable for babies aged 6 weeks to crawling 
Baby Yoga & Massage Combined classes are suitable from 10 weeks - crawling
Massage, Music and Movement classes are suitable for children aged 4-6months - 2 1/2years old
Toddler and Children's Yoga is suitable for children aged 18 months to 7 years
Toddler/Preschool Yoga is suitable from 18 months to 4 years
Preschool Music and Movement is suitable from 12months to preschool age (4 years)

Thank you for your time completing this form... I look forward to meeting you soon. If you have any questions or problems with the form, please email pattacakebabymassage@hotmail.co.uk
or call/text 07450292752 - much love, Nikkita x 
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Email *
Name (Mother/Father) *
First Child/Babies Name *
First Childs DOB *
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Second Child/Babies Name
Second Childs DOB
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Address *
Postcode *
Main Telephone Number *
Course Venue (please select one) *
Which course/special event would you like to attend ?

 *
How would you prefer to receive class info *
Name of Emergency Contact *
Tel No of Emergency Contact *
Where did you hear about my courses? *
For Baby Massage/Yoga - have you and your baby had your 6 week postnatal check up? *
Did your medical professional have any concerns, if so what? *
Will your baby/child have immunisations within 48 hours of a baby massage/yoga session? *
Do you or your baby/child have any allergies? *
Is there anything that would prevent you as the parent/carer from doing gentle stretches with your child/ren? If yes, please explain below... *
Is there anything about the birth of your baby/child, and how you experienced it that might be useful to know? *
Does your baby/child have any health concerns, including colic, clicky hips, reflux etc? Please give details below.. *
Safety Guidelines/Disclaimer
Please read these guidelines carefully before you attend your first class. 

Parents work with their own baby/child.  

When practicing with your baby/child, never rush or force anything. If you feel stressed or tense, just take a break and come back to the practice later. Always ensure that you feel safe, secure and confident with the way you are holding or working with your baby. Never do anything that you do not feel comfortable with.  

If your baby/child is unwell, it is best not to attend the massage or yoga class. If your child is crying excessively and cannot be comforted, he/she may be ill. Never practice on a distressed baby, or if your baby is limp, pale, has a temperature, or any difficulties breathing. Please seek appropriate medical help. 

It is not recommended to practice within 48 hours of your baby’s immunisations. You are still welcome however to come along to the session and you can either sit and watch and then practice at home or you can join in and practice the strokes on a doll instead. 


 Covid 19

Please DO NOT ATTEND class if you have any of the following symptoms;

o   a new continuous cough

o   a high temperature

o   a loss of, or change in, your normal sense of taste or smell​

· We require that you inform us immediately if you test positive for COVID-19 within 14 days of attending a class with us.

IN THE EVENT OF ANOTHER LOCKDOWN, LOCAL OR  NATIONAL, OR CLASSES NEED TO BE STOPPED DUE TO AN OUTBREAK OR NEED FOR QUARANTINING, CLASSES WILL RESUME ONLINE VIA ZOOM.

I agree to the above disclaimer/safety guidelines and agree to keep my teacher fully informed and updated should there be any changes in mine or my child's health before, during or after attending any classes. *
PHOTOGRAPH CONSENT
  • CONSENT TO USE OF PHOTOGRAPHS 
    As you know it is really helpful for other parents who are looking to book a class/course to be able to see pictures on my website and social media channels (Facebook/Instagram) of what happens in a class. There is absolutely no pressure to agree but if you would be happy to consent to me taking pictures, please would you be kind enough to complete the details below. 
     
    If you confirm you are happy, any pictures taken will be used for advertising, on my website and social media channels.
Are you happy for photos to be taken of you and your child? *
Are you happy to be contacted by Patta Cake Parent & Baby Wellbeing about further classes/events and helpful information to support you and your child? *
I understand missed classes are non refundable and once payment has been made, unless notice is given at least 2 weeks before the course starts AND providing your space can be filled, the fee is NON REFUNDABLE *
Please sign below to agree to all of the above and confirm you have provided the answers to the questions to the best of your knowledge (please type your name below) *
Date signed *
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PAYMENT
All BLOCK bookings and payments must be sent to the following account 

Mrs nikkita McCutcheon
11-14-64
10745164

YOUR SPACE IS NOT CONFIRMED UNTIL YOU HAVE BOOKED AND PAID
THIS FORM DOES NOT GUARANTEE YOUR SPACE ON ANY CLASS, IT IS PURELY A HEALTH FORM TO GO ALONGSIDE YOUR ACTUAL BOOKING.

If you are attending a PAYG class - payment is due via Cash or card on the day

£6 massage music and movement
£7 baby yoga and massage 
Thank you for your time! I look forward to meeting you all soon. If you have any questions, please email pattacakebabymassage@hotmail.co.uk
or call/text 07450292752
A copy of your responses will be emailed to the address you provided.
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