Registration Forms: Baby

Please complete these two forms below as part of your registration. Part One is the Registration Form. Part Two is the Liability Release Statement and Communication Guidelines.

Please click SUBMIT for Part One before moving onto Part Two. They are two separate forms.

First and Last Name(required)

Email(required)

Address (including city and state) (required)

Phone Number(required)

Significant Others Name

Baby's DOB (and due date, if applicable because baby was born premature)(required)

Baby's Name(required)

Birth Weight(required)

Current Weight(required)

Twin's only: Baby #2 Name

Twin's only: Baby #2 Birth Weight

Twin's Only: Baby #2 Current Weight

Has your baby been healthy and gaining weight since delivery? If any complications or health problems please explain.(required)

Siblings Names and Ages

Pediatrician(required)

How did you hear about Infant Basics and Toddler Training?

Type of Consult: (In-Home Consult; Phone/FaceTime Consult; Email Support Only Consult)(required)

*Please click SUBMIT before moving onto Part Two*

Part Two: Please sign the Liability Release Statement and Checkbox that you have read, understood and agree to the Communication Guidelines then click SUBMIT.

Liability Release Statement

Anytime that you are concerned about you, your baby or notice symptoms, call your OBGYN or pediatrician’s office. This consult and book/dvd are designed to provide information on the care of babies. It is intended as reference material only, not as a medical manual. This consult is done with the knowledge that Infant Basics and Toddler Training, LLC or Moms On Call, LLC specifically disclaim all responsibility for any liability, loss, or risk-personal or otherwise-to any parent, person, or entity with respect to any illness, disability, injury, loss, or damage to be caused, or alleged to be caused, directly or indirectly, by the use or application of any of the contents of this consultation.

This consultation does not take the place of your OBGYN or pediatrician’s visits or recommendations. This consultation is used as a supplement to your OBGYN and pediatrician’s recommendations. Use the information obtained as a guide for your own parenting choices.

Infant Basics and Toddler Training Communication Guidelines

If you are ever concerned that you or your child may be experiencing a medical emergency, please call your pediatrician or 911 right away.

Individual results may vary based on methods and consistency implemented by caregivers.

All fees will be clear and agreed upon prior to any service being rendered.

1. Please state the name, age, and current weight of your child at the beginning of each e-mail or in the subject line. This is very important for communication.

2. State your questions in bullet point format, as this will help ensure I answer your exact questions.

3. Be as specific as possible with your current routine and schedule.

4. I typically respond in less than 24hrs Monday thru Friday (excluding holidays + vacation). I guarantee a response within 36 hours. I do take the 11 annual federal holidays off.

Vacation Dates 2023

October 16-17

November 23-27 (Thanksgiving)

December 22-26 (Christmas)

5. If you encounter a problem that you feel requires an immediate response, this is typically a good indication that your pediatrician should be notified.

6. I LOVE what I do, but faith and family come first on the weekend. Emails received on Saturday-Sunday will be responded to on Monday.

7. If I am going to experience a temporary change in my schedule (such as vacation, family illness), which could affect my ability to respond to my current clients in my typical fashion, I will let you know.

As always, I consider it such an honor to be asked to serve and support your family in this way!

Liability Release Statement

Please complete these *two* forms below as part of your registration. Part One is the Registration Form. Part Two is the Liability Release Statement and Communication Guidelines.

Please click SUBMIT for Part One before moving onto Part Two. They are two separate forms.

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Please complete these two forms below as part of your registration. Part One is the Registration Form. Part Two is the Liability Release Statement and Communication Guidelines.