Baby Milestones Program Interest Form

Baby Milestones Program Interest Form
Welcome to the Baby Milestones Program Scheduling Survey!

Thank you for your interest in our expert-led program for babies aged 0-2.

Please use this form to register your details and vote for the best day and time to run this 1.5-hour session.

Your feedback directly helps us finalise our schedule.
Parent & Child Details
Parent/Carer Full Name:

First NameLast Name
Parent/Carer Email Address:
example@example.com
Parent/Carer Phone Number:
Please enter a valid phone number.
Child's Name:

First NameLast Name
Child's Date of Birth:

MonthDayYear
Date
Are you registering twins or an additional sibling?

YesNoPossibly
How Can We Support Your Family?
What is the main developmental area you are focusing on right now?

Tummy Time / Core StrengthReflex Integration / Head ControlVisual Tracking / Sensory ExplorationConnecting with other parents / CommunityOther
Is there anything else we should know about your baby (e.g., reflux, sensory sensitivities, early challenges)?
Vote for Your Preferred Schedule
Which day/s are you most available for the 1.5-hour session?

MondayTuesdayWednesdayThursdayFridaySaturday
Which time slot generally works best for your family?

9:30 AM – 11:00 AM11:30 AM – 1:00 PM1:30 PM – 3:00 PMOther
Consent & Submission
Consent to being contacted by us*

I consent to Play Move Improve contacting me to discuss enrolment and finalize the schedule.
Thanks for your time.
Should be Empty:

Parent & Child Details