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Urban Kneads Mother And Baby Client Consultation Form PARENT’S DETAILS Title First Name Surname Date of Birth Address Home No Mobile Email Occupation Postcode No of Ages Children GP Name GP Address GP Tel No How Did You Hear About Urban Kneads? BABY’S DETAILS Full Name Date of Birth Health Visitor Has Baby Attended Their Paediatric Check (around 6 – 8 weeks?) Yes No BIRTH DETAILS & BABY’S HEALTH Weight At Time Of Enrolment Type of Birth Does Baby Suffer From Any Medical Conditions Or Allergies? Does Baby Have Any Know Hip Problems? VACCINATIONS Date Reactions 2 months 3 months 4 months POSSIBLE CONTRAINDICATIONS AT TIME OF ENROLLMENT Vomiting Yes No Skin Rash Yes No Infections Yes No Cut / Wounds Yes No Diarrhoea / Constipation Yes No Temperature / Fever Yes No Bruising / Swelling Yes No Scars / Inflammation Yes No Any Other Yes No I confirm that all the information given is correct and up to date. I understand all information recorded concerning me and my baby will be held as strictly confidential. Signed: Date: COURSE DETAILS Preferred Start Date & Time Baby Massage Baby Yoga Dads’ Course Cancellation Policy Once your Client Booking Form and payment is received, it is strictly NON-REFUNDABLE. The only exception to this is if the cancellation is due to a medical condition, which (at Urban Kneads’ discretion), genuinely prevents you from participation in your chosen class. In these approved circumstances, a £7.50 administration charge will be deducted from your full refund to cover the cost of booking time, bank charges and postage. TRANSFERS: We will consider a transfer to an alternative course or later course (subject to availability) but require at least 10 WORKING DAYS NOTICE to approve said transfer. Transfers arranged later than 10 days prior to commencement of booked course may be subject to a 25% cancellation charge, to take into account the fact that we may not have time to find a replacement for your original booked place.
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