Baby Gross Motor Class Registration Form

Baby Gross Motor Class Registration Form

Please fill out the form below
Parent/Caregiver Name*

First NameLast Name
Child/Participant Name*

First NameLast Name
Gender
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Cell Phone Number*
Format: (000) 000-0000.
Email Address*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Terms & Conditions
I understand that my data will be strictly confidential. This clinic does not share any information without written consent.

I confirm that all information in this form is true and accurate.

I consent for my child to be part of the group gross motor classes.

Refund Policy: No refunds for missed classes. Makeup class offered upon availability or a 15 min virtual session. Up to 1/session.
Client Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
BABY GROSS MOTOR CLASSES: START Date: Week of SEPTEMBER 21/2026, 6 week session, 45 mins/class, in clinic (located in Vaughan at Dufferin and Major Mackenzie) **An insurance receipt will be provided after each class attended*
prevnext( X )
Tummy & Bottom: Thursdays 12:00 pm
September 24- October 29. This class focuses on the following Gross Motor Skills: 1) Tummy Time 2) Rolling 3) Sitting Balance 4) Core Strength and Stability

$420.00 CAD Quantity



Hands & Knees: Thursdays 11:00 am
Septmeber 24- October 29. This class focuses on the following Gross Motor Skills: 1) Transitions in Sitting 2) 2-PT Kneeling 3) 4-PT Kneeling 4) Transitions in Kneeling 5) Crawling

$420.00 CAD Quantity



2 Feet: Tuesdays 11:30 am
September 22-October 27. This class focuses on the following Gross Motor Skills: 1) Transitions to Standing 2) Standing Balance/Core Strength. 3) Cruising 4) Facilitated Walking

$420.00 CAD Quantity



Total

$0.00 CAD
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Baby Gross Motor Class Registration Form

Terms & Conditions

BABY GROSS MOTOR CLASSES: START Date: Week of SEPTEMBER 21/2026, 6 week session, 45 mins/class, in clinic (located in Vaughan at Dufferin and Major Mackenzie) **An insurance receipt will be provided after each class attended*