PAR-Q Form (adult classes)

Please complete the following form before attending your first class.

First name

Email

Class attending

Have you recently had an operation or illness?

Do you have any medical conditions or injuries that the teacher needs to be aware of?

Do you have any allergies?

I confirm that the above infomation is correct and that I am fit to attend dance class

Last name

Phone

Emergency Contact

Do you suffer from any of the following?

Angina

Back problems

Diabetes

Epilepsy

Joint problems

Asthma

HIgh blood pressure

Chest pain

Dizzy spells

Fainting

Are you currently pregnant?

How did you hear about Dragonfly

I agree to notify the teacher should a change occur that may affect my ability to take part in a dance class

Thanks for submitting!

Call

07306 666 131

Email

dragonfly.dpa.stafford@gmail.com

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Ballet - Tap - Modern - Jazz - Pointe - Acro - Contemporary - Commercial - Conditioning & Stretch - Pilates - Adult Tap - Adult Ballet - Adult Jazz - Silver Swans®

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