Baby Massage and Baby Yoga Parent and Baby Registration Form

First Name

Last Name

Which course/workshop are you wanting to book on to?

Phone Number

Address

Your baby's date of birth

Your baby's name

Baby's gender

Will you have had your 6-8 week GP check-up?

Were there any concerns raised from this appointment?

Does your baby have any health issues?

Does your baby have any known allergies?

Is your baby on any medications? If yes, please state which medications.

Does your baby have any skin problems?

Will your baby have had immunisations within 72 hours of attending a class?

What gestation was your baby born at (in weeks)?

Do you have any mobility issues? Do you find it difficult to sit for extended periods of time?

Do you have any learning difficulties? Any hearing or sight problems?

Do you have any chronic health problems?

Is there anything else you think I should know?

How did you hear about Cocoon & Bloom?

Do you consent to photographs being taken during the class which may be used by Cocoon & Bloom for promotional purposes?

Do you consent to contact via email to let you know about future Cocoon & Bloom events that may be of interest to you?

Baby Massage and Baby Yoga Registration Form

Time is TBDLocation is TBD