Registration Form For Baby Massage Classes

Baby Massage Registration Form

Name of Child

First Name

Last Name

Date of Birth

MM

DD

YYYY

Workshop Selected

Parent / Guardian Name

Phone Number

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is the child suffering from any health/skin related issues?

Yes

No

If you answered "Yes" to the above question, please describe the condition

How did you find out about the class?

I agree to pay the course fees (if applicable) on presentation of an invoice

Please check this box to confirm your acceptance