Your Details
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Mobile number
Year of Birth
This class is recommended for ages between 6 and 66.
Bringing Children?
Are you intending to bring children?
Yes
No
Child 1 Age
Child 2 Age
Parent acknowledgment
*
I will supervise my children, escort them to the toilets if needed, and if they become disruptive I will leave the class and try again in the future.
My children have no known health conditions that should prevent them from exercising; and if such a condition was to develop, the parent will remove the child from the exercise and seek professional guidance before returning them to class
Pre-Activity Screening (PAR-Q)
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
*
Yes
No
Do you feel pain in your chest when you do physical activity?
*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
*
Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
*
Yes
No
Do you know of any other reason why you should not do physical activity?
*
Yes
No
Health Information
Please describe any current or past health issues, allergies, or medications we should be aware of.
More about the class
I understand this is a fitness class, not a performing arts class
*
I confirm
I understand this class is not about being a "good" dancer, and I will both not be hard on myself for my pace of learning, neither will I be judgement to others who may not be executing the movement according to "performing arts" expectations
*
I confirm
Photos and videos will be captured in class and shared on Instagram. The reason is to motivate and inspire others to exercise more and to encourage people to choose to become instructors themselves.
*
I support this
My interests
I would like to post videos on my Instagram too
*
Yes
What is your Instagram handle?
I am interested in the following:
Exercising for my health and fitness
Volunteering to help more people exercise
Certifying to become an instructor, to teach my own class
Acknowledgement
I am aware this application will need to be made every 3 months
*
I understand
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Apply
Apply
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