Baby & Me: Move, Talk, & Eat Registration 🌟

Baby & Me: Move, Talk, & Eat
Join us at Happy Hearts Playspace for a warm, play-based parent-and-baby class led by a pediatric occupational therapist and speech-language pathologist from Leading Therapy Home! Understand what your baby is working toward, learn simple ways to support development during everyday play and meals, and get your questions answered by pediatric OT and speech-language experts!

Ages: 6–15 months
Dates: Mondays, September 28 - November 9 (no class October 12)
Time: 12:30-2:00 (60 min with therapists + 30 mins free play at Happy Hearts)
Price: $299/child for full 6-week series
Parent/Caregiver & Baby Information
Parent/Caregiver Full Name

First NameLast Name
Email Address
example@example.com
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Baby’s Full Name

First NameLast Name
Baby’s Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Baby’s Age at the Start of the Series
Parent/Caregiver Relationship to Baby
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Does your baby have any allergies or dietary restrictions?
If yes, please describe.
Anything else the OT and SLP should know about feeding, movement, communication, sensory needs, or development:
Questions or topics you hope the class will address:
How did you hear about this program?

Other
Acknowledgments and Signature
Acknowledgment
Parent/Caregiver Electronic Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

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Baby & Me: Move, Talk, & Eat — Six-Week Series

Registration for one child for the full six-week series.

$299.00

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Baby & Me: Move, Talk, & Eat

Parent/Caregiver & Baby Information

Acknowledgments and Signature

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