Health Waiver Thank you so much for taking 2 minutes to fill out this form. We look forward to dancing with you soon! Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *First and Last nameEmail *Phone *How did you hear about us? *Social Media AdvertismentWord of MouthLocal community centreFriend/familyOtherHave you ever taken Dance or movement classes before? *YesNoIn the living roomDo you have any of the following conditions?Low/High blood pressureDiabetesAsthmaCurrent/recent pregnancyRecent OperationsIf you answered YES to one or more of the conditions above please provide more details hereIf you answered 'YES' to any of the health questions; I agree to take medical guidance before attending the dance class.YesN/APlease specify if you or your young groovers have any support needs I agree to monitor my own response to the dance class, take rests when required, ensuring I listen to my own body and only push as far as I am comfortable with. *I agreeEmergency Name and Contact *Name and Phone numberI agree for Renata Commisso to take captured photos and videos of myself and/or child or legal ward. I understand that the photo/video will be retained by Renata Commisso on their electronic database with the intention that it may be used on publicly available promotional material issued from time to time. I am aware that I may request a copy of the photo(s) that I/ my child/legal ward is in. *I agreeI disagreeSign-up to our newsletter?Would you like to sign up to find out more about our community?Submit