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 lindsey@WeeBitsforfamilies.org or  847-223-7433, ext 203

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Child’s Name:                                                       Date of Birth:                                                                        

Parent’s Name:                                                     Telephone number:                                                    

                                                                           Email address:                                                          

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

No

Yes, please explain:

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

No

Yes, please explain:

 

 

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

No

Yes, please explain:

Is there a family history of developmental issues?

No

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)__________