BANDALOOP INTAKE FORM
Take a moment to tell us a little bit more about yourself so that we may enhance your educational experiences. You'll be asked personal, medical/emergency information and movement background details.

NOTE: In the event of an Emergency we will contact 911 followed by the emergency contact person you provide. This information will only be shared with the Teaching Staff of your program and should you lose consciousness the Staff will have all of the necessary information to provide Medical Professionals.

If you have any questions or concerns please email Workshop@bandaloop.org

DANCER COURTNEY MORENO on CALVINS SIMMONS THEATER photo by Krystal Harfert

Email address *
NAME: First Last *
Your answer
BIRTHDAY *
MM
/
DD
/
YYYY
PHONE: *
Your answer
EMERGENCY CONTACT: First Last *
Your answer
EMERGENCY CONTACT: Phone *
Your answer
MEDICAL: ALLERGIES/CURRENT MEDICATIONS *
Your answer
MEDICAL: INURIES (Past + Present)
Your answer
HARNESS SIZE: measured by waist size which is around the belly button. *
MOVEMENT EXPERIENCE: Briefly describe your movement experience in the 'Other' option. *
Required
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