Baby Massage/Baby Yoga and Learn Stretch and Play Parent and Baby Registration Form

Name (Mother/Father)

First Name Last Name

Babies Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Area Code Phone Number

Email

example@example.com

Date of Birth of Baby:

*Note: baby massage courses are suitable for babies aged 8 weeks to pre crawling - Baby Yoga is suitable from 10 weeks to around 14months and Learn Stretch and Play classes are suitable from 4/6months to around 3 years old

Course Venue (please tick)

Dinder Village Hall, Wells, BA3 5PF

Please choose which course you would like to join

Introduction to Baby Massage Workshop December 7th - Dinder Village Hall, Wells 9.45-10.45am £10 Introduction to Baby Massage Workshop December 14th - Dinder Village Hall, Wells 9.45am - 10.45am £10 5 WEEK Baby Massage Course - January 2021 - starting Monday 11th January at 10am - 11am - £45

Would you prefer to receive info by email / text or post?

Name of Emergency Contact

First Name Last Name

Phone Number of Emergency Contact

Area Code Phone Number

Where did you hear about my courses:

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 have immunisations within 24 hours of a baby massage session? If yes, please refer to the safety guidelines below.

Do you or your baby have any allergies?

For Baby Yoga / Learn Stretch and Play classes, is there anything that would prevent you from doing gentle stretches with your baby. If yes, please explain:

Is there anything about the birth of your baby, and how you experienced it that might be useful to know?

Does your baby have any health conditions (including colic, clicky hips, reflux etc...?) Please give full details below.

Safety guidelines

Please read these guidelines carefully before you attend your first class.

Parents work with their own baby.

When practicing with your baby, 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 is unwell, it is best not to attend the massage class. If your baby 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 24 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 COMPLIANT CLASSES

I am so excited to welcome parents and babies back to face-to-face classes but there are some changes to how classes will operate to keep everyone safe. Please ensure you read the following and sign to agree the conditions.

· MASKS - masks or a face covering MUST be worn when entering the venue and in all common areas within the venue. Once you are sat in your designated space you can remove your mask. However, if you get up to use the toilets, or move around, you MUST pop your mask back on.

· All mats will be at least 2 metres apart and you will be asked to stay in your area.

· Unfortunately I am no longer able to provide cushions for people to sit on, however you are welcome to bring your own as we will be sat on the floor for the duration of the class and the floor can become uncomfortable.

· please provide your own towel or blanket to use for your baby to cover over areas that we are not massaging, and any toys that will make baby feel at home (nothing over-stimulating).

· Unfortunately, at this present moment, I am unable to serve refreshments but feel free to bring your own drinks in a lidded cup to avoid spillages and any refreshments of your own to have at the end of the class.

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

· You will be asked to sanitise your hands on entry, and on leaving the venue.

· We must ask you to follow one-way systems when indicated.

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

YOU WILL BE REQUIRED TO COMPLETE A COVID MEDICAL QUESTIONNAIRE PRIOR TO ATTENDING EACH CLASS

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.

Disclaimer
Please sign the following disclaimer.

I have read the above safety guidelines and will ensure that I adhere to them.

I understand that before I attend each class I am expected to answer a COVID MEDICAL QUESTIONNAIRE

I understand that on arrival at the venue, I should scan the QR code on my smart phone, however, if I do not have my smart phone, my details will be stored after each session and made available to TRACK AND TRACE should they need to be.

I take full responsibility for myself and my baby, and for everything that happens to me and my baby in relation to the Baby Massage/Yoga class.

If I have any doubts, I will seek the advice of my medical professional before proceeding with Baby Massage classes.

I will keep the Baby Massage Teacher informed of any health issues that arise over the course of the classes, both for me and my baby.

I understand that refunds are not possible for missed classes.

I understand that in the event of another lockdown, national or local or classes need to stop due to an outbreak and need for quaratining that the remainder of the course will be taught online via ZOOM. No refunds will be given.

I understand that payment is due IN FULL at the time of booking to confirm my place as spaces are limited and once payment has been made, no refunds will be given.

I agree to the above disclaimer:

CONSENT TO USE OF PHOTOGRAPHS
As you know it is really helpful for other parents who are looking to book a course to be able to see pictures on my website / facebook page 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. Just to clarify - the pictures will only be to show some of the massage moves we do or a group shot and I can show you the pictures as I take them for you to approve before use if you prefer.

If you confirm you are happy, any pictures taken will be used purely on Patta Cake Baby Massage's Facebook page, for Publicity and on the Website. I understand that should Patta Cake Baby Massage want to use them for anything other than the above, I will be contacted before.

I am happy for photos to be taken of me and my baby during class:

I would like to sign up to Patta Cake Baby Massage and Yogas newsletter to receive helpful information to support me and my baby as well as find out more about additional classes and courses.

Date signed

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:

Clear

Payment is due at the time of booking and can either be sent via BACS to:

Mrs N McCutcheon

Ac: 10745164

sort: 11-14-64

or via PAYPAL to

pattacakebabymassage@hotmail.co.uk

please ensure you send using the FRIENDS and FAMILY option.

Thank you for completing this form. Please keep a copy for your information. The information you give is confidential. Thank you.

Baby Massage/Baby Yoga IN PERSON Parent and Baby Registration Form

The birth of your baby