Rose Hibberd Toddler Yoga Health Check All details will be kept strictly confidential Your name (required) Email (required) Your childs’s name (required) Your child’s date of birth (required) Your child's gender (required) Does your child have any medical conditions? (Yes/No) (required) —Please choose an option—YesNo If yes please give details Does your child have any allergies (Yes/No) (required) —Please choose an option—YesNo If yes please give details Do you have any medical conditions? (Yes/No) (required) —Please choose an option—YesNo If yes please give details Any other information Health check consent I give my consent for the information I have provided in this Health Check Form to be stored and accessed by the MamaBabyBliss Teacher with whom I have booked a class or workshop so that she may take into consideration any conditions that may be relevant to the class or workshop I wish to attend. I understand that this information will be kept securely on file for as long as I attend this class or workshop. Health check consent (Yes/No) (required) —Please choose an option—YesNo Photography disclaimer Occasionally photos may be taken in class. Please let us know if you give your consent to any photos being published in MamaBabyBliss marketing (Yes/No) (required) —Please choose an option—YesNo