Form

Name and surname of the parent(s) *

Address *

E-mail address *

Phone number *

Name child(ren) - write "BABY" when pregnant *

Date of birth child(ren) - estimated delivery date *

Child(ren) born before 37weeks pregnancy? *

If you answered YES to the previous question, please give some more information on gestational age at birth and postnatal evolution

In which aspect of babywearing are you interested? Several options possible. Each aspect stands for a seperate appointment. *

Who wants to learn? *

Me

My partner

My partner and I

Private group session

Please take into consideration that more time is provided for a dual session or group session. Feel free to invite someone to take care of your child during the session. If this person would also like to participate, this will be considered a dual session.

Previous babywearing experience *

Any babywearing system at home? *

You do not need to buy a babywearing system in advance.

Size clothes child(ren) *

If you are interested in a carrier fitting session, please add a short description of the body type of the parent(s). This is valuable when making a preselection of baby carriers. For example: shoulders, waist, breast, lenth - partners with different body types

Babywearing influences the development of your child(ren). Developmental milestones also affect babywearing. Please indicate which milestone your child recently reached?

Still growing in the belly

Newborn

Lift, hold and turn head to look around

Stay seated when someone puts me down

Independently come to a seated position

Crawling

Walking with help

Walking independently

Are there any medical issues (physical or emotional) of parent(s) or child(ren) that can affect babywearing? For example: neck/shoulder/back issues, ceserean section, pelvic girdle pain, hip dysplasia, breech position, uumbilical hernia, preferential position, gastro-esophageal reflux *

Indicate your preference for time babywearing session *

Morning (9-12u)

Afternoond (13-16u)

Evening (19-21u)

Workday in the week

Day in the weekend

Please take into account the signals and needs of your child(ren) such as clustering (breastfeeding).

How did you find out about Numinatal?

Online: website, facebook, instagram

Referral by healthcare professional

Friends or family

Other

During a babywearing session or the follow-up, pictures can be taken or shared. Please indicate your preference as parent(s) regarding these images. *

YES - image recording permitted, images may be shared with parent(s)

YES - image recording permitted, images may be shared on website and social media Numinatal

YES - image recording permitted, images may be shared in professional courses in which Numinatal participates (Babywearing, Dunstan Baby Language)

NO - image recording not allowed

Any questions or suggestions?