Registration Form - The Nurtured Child

Parent-Infant Class Registration Form

Child's Name: *

Child's Birth Date: *

Parent's/Guardian's Name(s): *

Address: *

Address:

City

State/Province

Zip/Postal

Country

Phone: *

Email Address: *

Medical Information *

(Any medical conditions or allergies we should know about)

Primary language spoken at home:

Child Care Provider or Attending Relative Information:

If the child is attending with a relative or child care provider, please complete the section below:

Name: *

Relationship to Child: *

Address: *

Address:

City

State/Province

Zip/Postal

Country

Phone: *

Email Address: *

Participant Information

Tell me a bit about your child. How would you describe their temperament and personality traits at this early stage of development? What is their daily routine?

Has your child previously attended playgroups, or play dates with 2 or more children?

What do you hope to learn and experience during a RIE® parent-infant class?

Is there any other information that will help me to get to know and understand your child better?

Class Information

Classes are held at 18 Bridge Street #3H, Brooklyn. Our parent-infant classes are designed to support parents and infants from birth to 2 years of age, therefore groups are on-going and remain together in continuous sessions until the youngest turns two. Many families stay for the entire span, which allows the children to thrive and form relationships with each other. However, families may join at any time as space allows, and tuition for the semester is prorated from the start date.

Release of Liability: *

By checking this box, I agree to the following release of liability.

I, and/or my minor child (collectively, whether one or more, “We”) hereby give permission to participate in this RIE® Certified Parent-Infant Guidance™ class provided by The Nurtured Child®, and we hereby release and hold harmless all employees, and volunteers associated with The Nurtured Child® from any and all liability and claims which may arise from my and my child's participation in this RIE® Certified Program.

Photo Consent *

By checking this box, I grant The Nurtured Child and it's authorized representatives permission to photograph my child’s participation in this program.

Occasionally, we may take audio recordings, photographs, or videos of the children participating in our programs. These materials may be used for educational, training, and promotional purposes. By agreeing to allow your child's photograph to be taken, you consent to your inclusion in these materials. No names of children or parents will be used without additional consent.

If you are human, leave this field blank.