Toddler, Tots and Teens Registration Form Group Booking Form (Toddlers & Tots to Teens) To confirm your place on the next workshop, please complete the following sections. Once submitted, you will receive an invoice for the total fee. Please note that your place will be confirmed once payment has been received.To confirm your place on the next workshop, please complete the following sections. Once submitted, you will receive an invoice for the total fee. Please note that your place will be confirmed once payment has been received. Data Privacy*To confirm your place on the next course, I require your contact details and your child's medical information. Your details will remain strictly confidential and will not be passed to any third parties. By submitting this form, you are consenting to being contacted with information about similar classes and treatments. Please check the Privacy Policy to see how your data is protected and managed: https://www.nestledinnurture.co.uk/privacy-policy/ I consent to my submitted data being collected and stored. Name of Primary Parent/Carer* First Last Phone Number*Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Address* Child 1 Name* First Last Your Relationship to Child* Child's Date of Birth* MM slash DD slash YYYY Child 2 Name First Last Your Relationship to Child Child's Date of Birth MM slash DD slash YYYY Child 3 Name First Last Your Relationship to Child Child's Date of Birth MM slash DD slash YYYY Do you or any of your children have any medical conditions or allergies?* Yes No If yes, please provide detailsWhat are your current concerns about your child or children?Are there any areas of your child's body they do not like being touched?What do you hope to gain from this workshop?*How did you hear about Happy Little Baby classes?*Search engineLocal flyer or posterSocial MediaExisting clientMagazine articleWord of MouthOtherI would like to attend the following course:* Children's Hand Reflexology Friday 11th November, 7pm Parent Declaration*I understand that the techniques learned are not considered to be a medical aid and therefore I must ensure that my child is also receiving appropriate care from a primary care provider if relevant. I realise the work is being given for the wellbeing of my child. I have stated all medical conditions that I am aware of and will update the practitioner of any changes in my child’s health status. I give consent for my data to be stored on the understanding that they will be in a secure place and kept confidentially. I can ask for them to be deleted at any time. Confirm Signature of Parent / Carer* Δ
