Retreat Day - Parent and Baby Registration Form

Name (Mother/Father)

First NameLast Name

Babies Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

Date of Birth of Baby:

*Note: the retreat day is suitable for babies aged 10 weeks to pre crawling

Course Venue (please tick)

The Warren, Upton Noble

Please choose which event you would like to join

mum and baby retreat - Sunday June 26th 10am-3pm £60Other

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

Name of Emergency Contact

First NameLast Name

Phone Number of Emergency Contact

Area CodePhone 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 or yoga session? If yes, please refer to the safety guidelines below.

Do you or your baby have any allergies? Please include any food allergies also.

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 that would prevent you from walking with your baby (in a sling if you have one) around a small woodland

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

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 THE EVENT NEEDS TO BE STOPPED DUE TO AN OUTBREAK OR NEED FOR QUARANTINING, AN ALTERNATIVE DATE WILL BE OFFERED.

I agree to the above disclaimer and agree to keep my teacher fully informed and updated should there be any changes in mine or my babies health before, during or after the course (especially if it is related to Covid19)

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:

Payment is due at the time of booking via BACS to:

Mrs N McCutcheon

Ac: 10745164

sort: 11-14-64

ref : your name

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

Patta Cake Parent and Baby Wellbeing Registration Form - Retreat Day

The birth of your baby