Intake form

Name *

Email address *

What type of dance are you interested in?

Please select at least one option.

Ballet

Hip Hop

Jazz

Contemporary

Tap

Ballroom

Latin

What is your current dance experience level?

What age group do you belong to?

What days are you available for classes?

Please select at least one option.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What time of day do you prefer for classes?

Please select at least one option.

Morning

Afternoon

Evening

Do you have any specific goals for your dance training?

Which service or services are you interested in?

Please select at least one option.

Fitness Kangoo Jumps

Cardiorespiratory fitness

Senior Fitness

Aerial yoga and gymnastics

Health gymnastics for young and school-age children

Zumba

Additional questions or comments

PureEnergy Dance Studio