Infant Massage Class Registration Form - East Valley Infant Massage
Thank you for your interest in infant massage classes. Once we receive your registration information, we will email you a secure link for payment.
Child's Name *
Your answer
Child's Birthdate *
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Additional Child's Birthdate
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Additional Child's Name
Your answer
Additional Child's Birthdate
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Additional Child's Name
Your answer
Caregiver's Name(s) *
Your answer
Today's Date *
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Address *
Your answer
City, State, Zip Code *
Your answer
Phone Number *
Your answer
Email address *
Your answer
Referred by *
Your answer
Please choose class option *
For The Birth Haven Classes: Are you a Birth Haven client?
Why are you interested in learning infant massage? *
Your answer
Is there any relevant information about the pregnancy, child birth, about you or the child, that I should know? *
Your answer
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