• Spring Fling! Registration & Screening Form

    Beginner ballroom dance for all levels

  • Rachel Balaban

    has been teaching dance for more than 15 years, dedicating her career to teaching movement to people with neurological disorders, specifically Parkinson’s Disease and Autism. She is committed to helping people access their vitality and health through the use of their own bodies and to make dance accessible to all populations. She is a Teaching Associate in the Brown University Medical School and is a former dancer and Board President at Newport Contemporary Ballet.

  • Gregory Tyndall

    trained formally in dance at the Cobb County Centre for Performing Arts at Pebblebrook High School. He has also trained at the Atlanta Ballet, Kirov Academy, Rock School for Dance Education, Nashville Ballet, and the Cincinnati Ballet. He earned his BFA from the Indiana University Jacobs School of Music Ballet Theatre and has been a dancer with Newport Contemporary Ballet since 2018.

  • Part 1. Contact Details

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Part 2. Personal Measurements

  • Sex

  • Part 4. Medical History

  • Have you ever suffered from...?*
  • Do you have any allergies (e.g: food, environmental, medications)?*
  • Do you experience any pain or discomfort during physical activity?*
  • Do you have any physical or mobility needs (e.g., wheelchair, crutches, prosthetics, etc.)*
  • Do you have a history of injuries? (e.g., joint, muscles, etc.)?*

  • Dance Experience & Preferences:

  • Have you participated in any dance classes or activities before?*
  • Do you have any preferences for the pace or style of the class (e.g., slower pace, more verbal instructions, adaptive movements)?*
  • Are there any particular accommodations or support needs that would help you feel more comfortable and included in the class?*

  • Consent & Acknowledgement:

  • I consent to the use of photos/videos taken during the class for promotional purposes.*

  • By signing below, I acknowledge that I have provided accurate information and understand that the instructors will use this information to create an appropriate and inclusive environment. I understand that it is my responsibility to inform the instructor of any changes in my health or needs during the course of the class.

  • Name and Date

  • Date*
     - -

  • Following the submission of this form a payment link of $20 per ticket will be sent to you from Jordan for the registration fee for this class.

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