Infant Massage registration

Infant Massage Class Registration

Goal of group:

To facilitate improved overall infant development, sensory-motor development, and social-emotional wellbeing for the infant and caregiver(s).


Target ages:   0-8 month old infants (or not crawling yet) is ideal


Dates: Saturdays 9:00-10:00  (5 weeks)


Cost: Tuition $50 - you will learn to massage a different area of the body will be targeted each week and add on as the class progresses); this includes all handouts and massage oil


Childcare is available for older siblings at $5/week or $20/session


Contact Lindsey Fry for questions regarding the program or to request a form for registration at or  847-223-7433, ext 203


Child’s Name:                                                       Date of Birth:                                                                        

Parent’s Name:                                                     Telephone number:                                                    

                                                                           Email address:                                                          

Were there any complications during pregnancy or delivery (Including caesarian section)??


Yes, please explain:

Have there been any complications since delivery (Including illness)?


Yes, please explain:



Do you have any concerns regarding your child’s development or has your child had any intervention?


Yes, please explain:

Is there a family history of developmental issues?


Yes, please explain:



Any other questions or concerns?




Identify 1-3 area(s) you would like to facilitate with infant touch-massage

___ Relive discomfort from teething              ___ Decrease congestion

___ Relieve gas, colic and GI discomfort      ___ Bonding

___ Skin stimulation                                      ___ Increase oxygen/nutrition flow

___ Deepen respiration                                 ___ Encourage midline orientation

___ Improve sensory awareness                  ___ Help baby sleep deeper /longer

___ Stimulate circulatory system                  ___ Increase vocalizations

___ Enhance neurological development       ___ Help baby learn to relax

___ Improve overall regulation


Please check all  the days that you will be available for (Saturdays  9:00-10:00):


___ April 26         ___ May 3      ___May 10     ___May 17    ___May 31


How did you hear about this class?

Do you have other siblings that would be present and/or need childcare?

___No     ___ Yes; age(s)__________