UConn Health Parenting Program

Dear parents,
Hello! Please use this survey to register for Learn Infant Massage, our 5-session course offered Tuesday mornings May 20, May 27, June 3, June 10, and June 17, 2025. This class will be held at the Bristol Public Library from 10:00-11:30 am. This course is ideal for parents and infants 6 weeks to 6 months old. Parents and other caregivers are warmly welcome to learn how to build an infant massage routine and infant massage strokes!

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* 1. Family Contact Information

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* 2. What is the name of your baby(ies)?

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* 3. What is your baby's date of birth?

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* 4. Which language do you prefer written materials in?

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* 5. Please tell me if you have any concerns or questions you would like to share with me?

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* 6. I understand that I am learning infant massage in order to share nurturing and compassionate touch with my baby.  If my baby or I experience any pain and/or discomfort during any class, it is my own responsibility, and not that of the instructor to stop or slow down my/our activity.  My comfort and my infant's comfort are critical, therefore I understand I can participate in the class at our own pace.  I know that I can feed, change and soothe my baby during the class and can follow my baby's lead.

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* 7. I understand that the physical and mental exercises taught by the educator or performed by me in the class(es) should not be construed as the substitute for medical examination, diagnosis or treatment and that I/my baby should seek qualified medical assistance for any physical or mental ailment that I/we are aware of.

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* 8. I understand the certified educators of infant massage are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe or treat any physical or mental illness and that nothing said in the course should be construed as such.  The class offers support and guidance, not diagnosis or treatment.

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* 9. Because massage and/or exercise is contraindicated (should not be done) under certain medical conditions, I affirm that I have consulted my baby's health care professional prior to participation and/or I am participating with my baby by my own choice in these classes/exercises.  I understand that there shall be no liability on the educator's part, and that I am responsible to seek professional advice for my baby for any reason.  

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* 10. To learn more about this infant massage parent education model, visit www.infantmassageusa.org

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* 11. How did you hear about our program?

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