Livewell | Harvest Baby Massage

Full Name*

Phone Number*

E-mail Address*

How did you hear about LiveWell? Have you attended a LiveWell service before?*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Baby's Details

Baby's Name*

Baby's D.O.B*

Please note this class is for babies UNDER the age of 1. This is due to insurance reasons. We tend to separate our baby massage classes into 'pre-crawler' and 'crawler' classes. However, for the Harvest taster, you are welcome to bring your little one along if they have started to move and explore. However, please note you will have to observe your little one at all times for their safety and the safety of other babies if they are on the move.

Does your baby have any medical condition that we should be aware of? If yes, please give details.*

Was your baby born prematurely? If yes, by how many weeks? This is simply for instructor information.*

Is there any additional information you would like LiveWell to know regarding either yourself or your baby prior to attending the Harvest Taster Class? All information provided is strictly confidential.

LiveWell Updates and Offers*

We like to give preferential booking notice and offers to previous attendees of LiveWell services. We also like to share information about workshops and classes. Please let us know if you would like to be kept on the LiveWell email list to receive this information.

Harvest Photography Informed Consent

Please note that this is a Free Promotional Event. For publicity purposes, LiveWell Waterford and other Waterford Harvest Festival media partners, including local newspapers, may wish to take photos/videos during the scheduled events of the Harvest 'LiveWell' Day. This includes in the class setting. These photos/videos will be used for media purposes by LiveWell Waterford & Waterford Harvest Festival and on the LiveWell Website, publications and/or social media associated with LiveWell Waterford and/or the promotion of future Harvest Festival Events.

THIS INFORMATION IS PROTECTED BY THE DATA PROTECTION ACT 1984.

I have read and agree to terms*

Live Well Waterford

Harvest Baby Massage

Harvest Baby Massage

Your Baby's Details

Harvest Photography Informed Consent

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