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Baby Massage Parent and Baby Registration Form

Please complete this information at least 72 hours before your first class

Mother's Name *
Mother's Name
Father's Name
Father's Name
Baby's Name *
Baby's Name
Second Baby's Name
Second Baby's Name
Only fill this section if you have twins attending a course.
Baby's Date Of Birth *
Baby's Date Of Birth
Address *
Address
Name of Next of Kin *
Name of Next of Kin
If so, please state
If yes, please remind Casey on the day of the class so that she can guide you on what you can or cannot do
Sensitive skin/eczema included
Is there anything about the birth of your baby, and how you experienced it that might be useful to know?
including colic, clicky hips, reflux, constipation etc…? Please give full details.
Which course or class would you like to attend? *
Hoop, Magazine, Facebook page, Online advert, Google search, Recommendation, Member of Sensory Land staff, Other
Safety guidlines *
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. Disclaimer Please sign the following disclaimer. • I have read the above safety guidelines and will ensure that I adhere to them. • I take full responsibility for myself and my baby, and for everything that happens to me and my baby in relation to the Baby Massage class. • If I have any doubts, I will seek the advice of my medical professional before proceeding with Baby Massage classes. • I will keep the Baby Massage Teacher informed of any health issues that arise over the course of the classes, both for me and my baby. By ticking the box you are saying that you have read and accept the terms of the disclaimer. The tick is a digital signature.