Tummy Time Group Registration

Tummy Time Group Registration

Exciting Opportunity for Your Baby: Tummy Time Group for Ages Birth - 5 Months! *Tummy Time can be Fun!, a way to bond with a baby, easy or challenging, modified as they get stronger and older. *What to Expect: 1.) 2 Weekly appointments for 4 weeks, each session lasting 1 hour. 2.) Activities to strengthen the baby's neck, shoulders, arm, and back, which help them be more prepared for achieving gross motor milestones such as sitting, crawling, and eventually walking. 3.) Prepare the baby for play skills: being able to reach for desired objects. 4.) Tummy Time prevent flat spots on the head due to spending too much time on their backs and prevents Torticollis. *Benefits for You and Your Baby: 1.) Fun! 2.) A Way to bond with a baby. 3.) Easy or challenging. 4.) Modified as they get stronger and older. *Who Can Join: 1.) Baby's from Birth to 5 Months Old 2.) Parents or caregivers are encouraged to participate alongside their baby. *Reserve Your Spot Today! Limited spots available, so don't miss out on this fantastic opportunity for your child's development. Call 586-293-1234 or visit our website to sign up and secure your spot in our upcoming Tummy Time Group!
Date*

MonthDayYear
Date
Parent's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent's Name*

First NameLast Name
Parent's Email*
Child's Full Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Child's Sex
Child's Birth Weight*
Child's Birth Height*
Child's Current Weight*
Child's Current Height*
Are there any precaution we should be aware of?*
Is there anything else we should know about your child before the group starts?*
Flourishing Lives Release of Liability

This is a legally binding Consent Form and Release of Liability made voluntarily by me, the undersigned Releaser, on my own behalf and on behalf of my heirs, executors, administrators, legal representatives, and assigns to Flourishing Lives. By the execution of this waiver of liability form, I acknowledge that the child listed above is capable of participating in the activities. I also assume full responsibility for all risks of the child participating in the activities, whether such risks are known or unknown to me at this time. I release and hold harmless this organization, leaders, employees, contractors, volunteers, and any agents from any claim the child or I may have due to he result of any injury or illness incurred during participation in the Flourishing Lives activities. In an emergency, I acknowledge that I am solely responsible for all medical and other costs arising out of bodily injury or any loss sustained through participation in this activity. I authorize program/office/facility staff to secure any licensed hospital, physician, and/or medical personnel for any treatment deemed necessary for the participant’s immediate care.
Flourishing Lives Photo/Video Release

I hereby grant Flourishing Lives the irrevocable right and permission to use photographs and/or video recordings of my child(ren) on their website and other websites and in publications, social media, promotional materials, educational materials, derivative works, or for any other similar purpose without compensation to me. I understand and agree that such photography and/or video recordings of my child(ren) may be placed on the internet. I also understand and agree that my child(ren) may be identified by name and/or in title in printed, internet, or broadcast information that might accompany the photographs and /or video recordings of them. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video and audio recordings, and any reproductions thereof, and all plates, negatives, recording tape, and digital files are and shall remain the property of Flourishing Lives. I hereby release, acquit, and forever discharge Flourishing Lives, its current and former trustees, agents, officers, and employees of the above-named entities from any and all claims, demands, rights, promises, damages, and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation.
Financial Responsibility

Full payment must be received to reserve your child's spot in this group. There will be no refunds.
By signing below, you certify that you are authorized to make decisions for the above-named child, that you agree to the liability releases as written, and that you agree to assume financial responsibility for services provided by Flourishing Lives.
Electronic Signature

My Products

Tummy Time Group - Birth - 5 Months

1/5/25 - 1/28/25 Mondays and Wednesday at 9am

$300.00 Quantity

Tummy Time Group: Birth- 5 Months

1/12/25- 2/4/25 Mondays and Wednesdays at 10 am

$300.00 Quantity

Total

$0.00

Credit Card

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