c r e a t i v e A f f e c t dance form

Name

Date

Phone Number

Please enter a valid phone number.

Email

example@example.com

Occupation

Age

Statement of Purpose/Reason for learning to dance

Student goals and desired outcomes

What has your experience with dance been thus far? Do you currently partake in any dance classes/events? If so, what are they?

Based on the answer above, have there been style of dances that you found the most enjoyable? Equally, have there been some that you did not enjoy?

Please feel free to provide any other information you feel is relevant

By choosing to participate in today's dance session and follow-up sessions, you understand there are risks to any physical activity and affirm that you are responsible for your personal health and well-being. I agree to inform my dance instructor of any activities or movements, which I feel could cause injury to myself. Adrienne Hite, c r e a t i v e A f fe c t shall not be held liable for any injury, loss, or damage to property and/or persons sustained during or as a result of participation in this dance session and/or recommended practices. Cancellations require a 24-hour notice in order to not be charged for the session. Paid sessions are non-refundable and expire one year from purchase date.

Student Signature

Date