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 Diana@rRejuvenatingLifestyle.com

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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