Dad & Baby Massage Booking Form 
Please complete booking form prior to attending any Baby Massage Class. Failure to complete will delay course start date. 

Please note, babies are most settled in class from 6 weeks old. Please contact tinytoesayrshire@gmail.com with any queries.

We look forward to sharing in some of your precious moments with your baby x
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Parent(s) Name 
Child(rens) Name 
Address
Contact Phone
Contact Email
Emergency Contact Details
Baby's Date of Birth (Ang gestational age if pre-term)
Are you or baby on any medication? Please give details.
Do you have any additional support needs you would like your instructor to be aware of? Please give details.

Do you have any cultural preferences you would like your instructor to be aware of? Please give details.



Do you have any chronic or acute health issues that may impact your ability in class?

Does your baby have any underlying health concerns? Please give details.

Would you describe your baby as having additional support needs? Please give details.

Do you or your baby have any allergies? Please give details.

Is there anything else you would like your instructor to be aware of? Please give details.

Do you consent to use of pictures/videos for promotion of future baby massage courses?

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I TAKE FULL RESPONSIBILITY FOR THE HEALTH OF MY CHILD AND MYSELF IN THE SESSIONS AND SHOULD THERE BE ANY MEDICAL CHANGES I WILL CONSULT MY INSTRUCTOR. I UNDERSTAND THAT I WILL BE RESPONSIBLE FOR MY CHILD THROUGHOUT THE COURSE.

Please tick to agree

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