Pre-Season Prep Registration

I’m excited to get started! I’d love a little injury and health history to help customize the program for you. Please answer the questions below with as much detail as you can.

Dancer's Name

First Name

Last Name

Dancer's Birthdate

MM

DD

YYYY

Parent's Name (primary contact)

First Name

Last Name

Parent's Email

Parent's Phone

(###)

###

####

1. Do you have any current injuries or specific areas of pain or tightness? If yes, note how long it’s bothered you and if any specific movements or skills bring up the most discomfort.

2. Using a 0-10 pain scale, rate how your body feels (on average) during class or rehearsal. 0 = No pain or discomfort at all; 10 = Highest level of pain

3. Please note any other health issues or concerns that would like me to be aware of.

4. What are specific skills, choreography (or qualities, dynamics) that you're seeking to improve? Or you can answer: "If I could wave a magic wand, I'd love to be better at _______."

Once you’ve submitted this information, please complete the liability waiver on the next page..