Baby Massage / Yoga Intake Forms

Thank-you for your interest in attending a Settled Petals Baby Group. We are really looking forward to meeting you and your baby.

All you need to bring is your lovely baby and a clean towel or blanket (this is to ensure your babys massage area smells like home).

Baby mats, Baby massage oil and refreshments for the grown-ups will be provided.

Really looking forward to having you in the class,

Susan

Your full name *

Your baby's name*

Baby's date of birth*

Your email address?*

Is your baby attending Baby Massage or Baby Yoga?

What date and location?

Does your baby have any health concerns, diagnosis or ongoing medical investigations? Please detail below

Massage only: We use Cold Pressed, Organic Sunflower Oil, as our baby massage oil. Parents will also be given the option of using Soothing Cheek Oil during the teething routine. This is a blend of calming essential oils in a skin softening mix of vegetable oils to soothe, calm and relax your baby whilst easing the pain of teething. Settled Petals strongly recommends completing a patch test prior to use. Use of this oil, is entirely at parents own risk. Please write your name to confirm that you have been made aware of this stipulation.*

We may use essential oils in a diffuser during the session. Do either yourself or your baby have any allergies which need to be taken into consideration?

Do you give permission for photos to be taken of you and your child and used in social media / advertising / website?

Please provide in detail, any additional information that you believe is relevant:

How did you hear about Settled Petals? *

TERMS AND CONDITIONS

BY SIGNING BELOW YOU AGREE TO THE FOLLOWING TERMS AND CONDITIONS:

MEDICAL DISCLAIMER: The information/advice provided during this consultation is not medical advice. You are not establishing a medical professional/patient relationship. The advice is for informational purposes only and is intended for use with healthy children without diagnosed medical conditions. The information provided is not intended nor is implied to be a substitute for professional medical advice. Always seek the advice of your Doctor or Midwife with any questions you may have regarding a medical condition or the health and welfare of your baby.

BABY OIL: The massage oil provided is organic, cold pressed sunflower oil. It is recommended that a patch test is completed before use. The oil is used at parents own risk.

DOCTOR APPROVAL: If your baby has any diagnosis, ongoing medication investigation, then you agree to consult with and get approval from your Doctor before following the advice or using the techniques offered during this consultation.

LEGAL NOTICE: In no event will Settled Petals / Susan Wallace be liable to you for any claims, losses, injury or damages as a result of reliance on the information provided. All though all attempts have been made to verify the information provided is accurate, Settled Petals / Susan Wallace does not assume responsibility for errors, omissions, or contrary interpretation of the subject matter within the consultation. Reliance on any advice given by Settled Petals / Susan Wallace is solely at your own risk.

REFUND POLICY: Refunds are not possible once this form is submitted.

COPYRIGHT NOTICE: The information provided may not be reproduced, republished, or transmitted in any form or by any means mechanical or electronic, including photocopying and recording, or by any information storage and retrieval system, without permission.

All information supplied by Susan Wallace either verbally, written or implied remains the property of Settled Petals at all times. Written permission is required to reproduce, record, publish or advise verbally any details of the classes, E-guides, charts, notes, advice offered or consultation transcript or summary in any format whatsoever. This includes but is not limited to any details published on any blogs, forums, or similar boards. Any information supplied by Susan Wallace / Settled Petals is confidential. Any passing of any information to anyone is strictly forbidden and subject to international copyright laws.

I have read and agree to the terms and conditions

Do you give permission for your details to be added to our email list? We will not share your information with any other parties

Signature*

To complete your submission and book your space simply click your event listed below.

Rooba products are complimentary to relaxation and massage. These are optional products. If you purchase them, they will be available on your mat at your first class. Details as follows:-

Rooba Dream Little One Sleep Oil: A carefully blended mix of pure essential oils including Organic Ylang Ylang, French Lavender, Roman Chamomile and Vetiver. 100% Naturally Derived

Rooba Soothing Cheek Oil: Contains organic calendula and organic arnica oils that are carefully bleneded with a specially selected choice of pure essential oils. The blend of oils is combined to soothe, moisturise, condition and nourish your baby's cheeks

Rooba Armotherapy Stone: Simply drop your favourite essential oils to the stone, and allow them to diffuse into the atmosphere

Purchase

Rooba Aromotherapy Stone£7.95

Quantity

Baby Massage 5 week class£42.00

Rooba Dream Oil£9.95

Rooba Soothing Cheek Oil£9.95

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Total £0.00

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