Rejuvenating Dance Meetup Survey
Event Timing: June 10, 2017 from 2:30 to 4:00 PM
Event Address: 2108 Kidwell Street, Dallas, TX 75214
Contact us at (1982-571-6368

Name *
Your answer
What is your age
Your answer
How did you hear about this meetup?
Would you be interested in receiving a blog on creating a healthy lifestyle?
Residence zip code *
Your answer
Rate your energy level on arrival to Studio B with 1 feeling exhausted and 10 feeling fabulous. *
Dance and Movement Experience
If you selected other-- please describe.
Your answer
Do you have any physical conditions that may require movement modification? *
If you answered yes or maybe, briefly describe your physical limitations that may require modification.
Your answer
Scan your body and rate your pain level with 1 feeling no pain, 5 moderate pain, and 10 serious pain. Please See the Instructor if you have any pain above a 5. *
Describe any pain above a five and any modifications you might need. *
Your answer
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