Stoke Central Mindful Movers Child Registration Form

Mindful Movers Child Registration Form
Stoke Central Mindful Movers Child Registration Form
Name

First NameLast Name
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Date of First Session

MonthDayYear
Date
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
YesNoIf yes, please specify
YesNoIf yes, please specify
YesNoIf yes, please specify
YesNoIf yes, please specify
YesNoIf yes, please specify
We would love to send you information on up and coming classes and events from Mindful Movers and BabyBeats by email. We will always treat your personal information with care and never sell them to other companies.
example@example.com
Yes please, keep me in the loop!
Please note in a Mindful Movers Class children work on their own, at no point will a teacher demonstrate with your child.

During Mindful Movers we aim to give your child a fun and effective class. To achieve this, we will never force your child to perform any exercise, position or stretch they do not feel comfortable with. They are allowed to participate or watch at any point during the class.

We do not recommend you attend a Mindful Movers class within 24 hours of any immunisations or sickness.

I will seek the advice of a GP or Health Visitor before commencing Mindful Movers classes if I have any concerns.

If any health issues, injuries or concerns for my child arise within the block of classes, I will inform my teacher and seek medical advice where appropriate.
I have read and agree with the above statement
Photo Release Statement

I give BabyBeats and Mindful Movers permission to use my photograph orphotographic image in official BabyBeats business, including website, newsletters, videos, media etc. I understand that photographic images or video may be used for news organizations and promotional purposes. I hereby waive any right that I may have toinspect or approve the finished product in which a photographic or video image may be used including the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied.
Yes, I agree with the photo release statementNo, I do not agree with the photo release statement
Should be Empty: