4-Week Infant Massage Class Registration Form Infant Massage Class Registration Duration: 1 hour each week for 4 weeks Location: True Self Yoga, Olympia Class Fee: $100 $90 for doula clients or when registered 3 weeks before the start of class Class Dates: * Parents Names: * Name and Pronoun you go by First Name Last Name Phone * (###) ### #### Email * How find you find us? * Word of Mouth Social Media Recommended by Birth Professionals Other Baby's Birth Date: * MM DD YYYY Birth Complications? * Do you or your baby have any health concerns? * Please write N/A, or list any you may have. Fees The Fee for this class is $100. A $10 early registration discount will apply when registration is mailed 3 weeks prior to the beginning of the class or if you have been Diksha's birth client. Please include the full class fee with the completed Registration Form to secure your spot! Checks can be made out to Diksha Berebitsky and mailed to: Diksha Berebitsky, 3344 Donnlley Dr SE, Olympia, Wa 98501 The class will be held at True Self Yoga 2727 Westmoor Ct SW #200, Olympia Date MM DD YYYY Name First Name Last Name Signature * It's ok to type your name I am looking forward to having you and your baby at our classes! Warmly, Diksha Berebitsky Thank you! Pay Class Registration Fees.
