Please take a moment to read and complete the below form.

Submission is required at least 24 hours before your first class. All information will be treated as strictly confidential.

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* 1. Parent / Guardian Name & Contact Details (mobile number & email)

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* 2. Child Name

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* 3. Child Date of Birth (DD/MM/YY)

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* 4. Child 2 Name

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* 5. Child 2 Date of Birth (DD/MM/YY)

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* 6. Please detail any relevant medical conditions, allergies, injuries, hip dysplasia, additional needs, medication (puffer / epi-pen), joint abnormalities, respiratory conditions etc.

You may be contacted to discuss.

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* 7. Emergency Contact Name & Mobile Number

Secondary contact. We will always call the parent / guardian if there is an emergency

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* 8. Additional Information

Please add additional student information here including additional attendees and names of children under 3 if attending a Kids Yoga session.

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* 9. At times, Nurture Wellbeing may take photographs or videos during classes and other activities for publication on the website, social media and marketing purposes.

If you do not wish to be photographed, please make this known at the time of booking. By agreeing to these terms and conditions you are granting Nurture Wellbeing the right to use photographs or videos and any adaptations of them, for all general purposes in relation to Nurture Wellbeing work including, without limitation, publicity materials, books, newspapers, magazine articles, social media, whenever Nurture Wellbeing choose to do so.

I will never take photographs or video of your baby during massage when they are fully naked, only when they are wearing a nappy and / or clothes and only if you have given your consent. Parents are permitted to take photographs of their child but only their child during classes.

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* 10. Wavier
I hereby agree to the following: I recognize that yoga and infant massage, as with any sport or physical activity, carries a risk of accident or injury. I am fully aware of the risks and hazards involved and hereby assume the risk connected with participation in a class with Christie Barker or Nurture Wellbeing.

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any physical fitness program. I affirm that my baby / child and I are in good health and suffer from no physical impairment that would limit his / her participation in the yoga activity or infant massage class. I understand that it is my responsibility to detail any injuries, allergies, additional needs and health conditions on this form.

If taking part in a baby class, I confirm that my infant has had their 6 or 8 week check and / or been confirmed free from any joint / skeletal disorders / abnormalities / conditions. If taking part in yoga, I confirm that I have been cleared to return to gentle exercise by my physician following my child's birth.

I understand that my baby should refrain from yoga or massage for 3 days after immunisations, in case of any side effects or soreness. I acknowledge that Christie Barker and Nurture Wellbeing will not render any medical services including medical diagnosis of my child’s physical condition.

In consideration of being permitted to participate in the yoga / massage classes, I agree to assume full responsibility for any risks, injuries or damages, known and unknown, which I or my child might incur as a result of participating in the program. In further consideration of being permitted to participate in the yoga / massage classes, I knowingly, voluntarily, and expressly waive any claim I may have against the instructor, the owner, or the leaseholder of the building for injuries or damages that I or my child may sustain as a result of participating in classes or workshops held by Christie Barker and Nurture Wellbeing.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above

Covid-19
Please refer to our Covid-19 Policy to be informed what we are doing to keep our community healthy.

If you are unwell, please stay home and contact us to arrange a make-up class.

As per Public Health Order’s, any attendees with exposure to Covid-19 must stay home for quarantine period. If your instructor test positive with Covid-19, unless a substitute teacher can be arranged, classes will be cancelled for the duration of illness and will reopen when a negative test OR symptom free for 72 hours.

A child or primary care-giver who tests positive for Covid-19 will be required to have a negative test before returning to classes OR be symptom free for 72 hours.

Please advise us if you test positive within 14 days of attending a class. If an attendee or I test positive for Covid-19, I will notify local officials immediately. These officials will help us determine a course of action for fellow attendees. Classes may need to pause to allow time for the local health officials to gain a better understanding of the Covid-19 situation prior to resuming classes. I will work with the local health officials to determine the appropriate next steps needed to stop or slow further spread of Covid-19.

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