BIPOC Dance Health Directory
BIPOC stands for Black, Indigenous, People of Colour.
This directory is for BIPOC health professionals who support dance health.
The intention of the directory is to provide a resource for BIPOC dancers and performing artists to find a support system that will address and validate their unique needs.
It is also a means to build the BIPOC dance health community, boost representation and opportunities for health access and inclusion.
* Required
Email address
*
Your email
Option 1
Clear selection
Option 1
Clear selection
Full Name
*
Your answer
Preferred Pronouns
Your answer
Profession
*
Your answer
Name of Clinic or Company
*
Your answer
Website
*
Your answer
Social Media Handles
*
Your answer
Languages spoken
*
Your answer
What Ethnic Community or Culture do you identify with?
*
Your answer
City and Country your practice is based
*
Your answer
Provide a brief bio of about your work in Dance Health
*
Your answer
Why do you think this resource is important for the BIPOC dance community?
*
Your answer
Would you like to be featured on the BIPOCdancehealth instagram account?
*
yes
no
Do you consent using a headshot and or action shot of you working or dancing in the website and social channels?
*
Yes I consent (please email your shots to
info@drblessyl.com
)
No I do not consent
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms