Complete form to book on to the Rub a Dub Baby Massage Course

Booking Form

Thank you for joining Rub a Dub Baby Massage classes, please take time to complete this enrolment form for insurance purposes. Your details will remain strictly confidential to Rub a Dub and will not be passed on to any third parties. We may contact you with information about future events or classes.

Name:
Address:
E-mail:
Mobil Number
Baby's Name:
Baby's Birth Date:
Baby's Birth Weight:
Does Baby Have any Allergies:
Has your Baby had his/her paediatric check? yes, No
Class area you would like to attend:
How did you hear about the classes:
Please give details if Baby has any illness/conditions/injuries
Please initial to confirm that all information given is correct and you give consent to receive Baby massage instruction from Sharon Cooper
Date:

I acknowledge that I am responsible for the safety and protection of my child at all Rub a Dub sessions.  I will keep my child with me at all times ( or with someone I agree to have in loco parentis responsibility).