The information provided here is for informational and educational  purposes only. It is not intended to replace, and should not be interpreted or relied upon as medical or professional advice. Always consult with a doctor, healthcare provider, or other medical professional before making any medical decisions. TUMMY TIME IS ALWAYS TO BE DONE WHEN THE CHILD IS AWAKE AND SUPERVISED, IN ACCORDANCE WITH THE AMERICAN ACADEMY OF PEDIATRICS. 

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Waiver/ Release of Liability


Review Privacy Policy

I agree to participate in Move, Develop, Thrive. I understand this is an educational series that is presented for the general population. It is not intended to replace, and should not be interpreted or relied upon as medical or professional advice. The information presented is not for providing physical therapy for any specific condition and my child listed has not been given a comprehensive evaluation or formal diagnosis for which this class is meant to treat.  

May 17, 2025

I understand that tummy time is advised to only be performed while the child is awake and supervised.

I Agree

I understand the information presented in this class and provided via video is meant for me alone and is not to be shared with anyone.

I Agree

 

First Parent's Name
First Name*
Last Name*
First Parent's Age Acknowledgment*
First Parent's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Parent's Signature*
Second Parent's Name
First Name*
Last Name*
Parent's Date of Birth*
Date of Birth
Third Parent's Name
First Name*
Last Name*
Parent's Date of Birth*
Date of Birth
Fourth Parent's Name
First Name*
Last Name*
Parent's Date of Birth*
Date of Birth
Fifth Parent's Name
First Name*
Last Name*
Parent's Date of Birth*
Date of Birth
Sixth Parent's Name
First Name*
Last Name*
Parent's Date of Birth*
Date of Birth
Seventh Parent's Name
First Name*
Last Name*
Parent's Date of Birth*
Date of Birth
Eighth Parent's Name
First Name*
Last Name*
Parent's Date of Birth*
Date of Birth
Ninth Parent's Name
First Name*
Last Name*
Parent's Date of Birth*
Date of Birth
Tenth Parent's Name
First Name*
Last Name*
Parent's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Child's name
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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