Step Change Studios: Live Dance Classes for Disabled People £3

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Register for our weekly dance classes taking place every Sunday at 12.30pm. Classes are for all abilities and take place at Bridgefield House, 219 Queensway, London W2 5HR. Sessions are £3 per class (1 hour). Once you register, we will send you payment details or you can pay in person in class. Our sessions provide a fun, supportive space to learn and enjoy dancing. Carers/siblings/friends welcome.

This programme is delivered in partnership with Active Westminster and Everyone Active. By completing this form you agree to us sharing information with Active Westminster for reporting purposes only. For queries please email: contact@stepchangestudios.com

First name and Surname *

Email *

Phone number

Postcode *

Date of birth *

YYYY

Emergency contact name and telephone number *

Gender *

Female

Male

Prefer not to say

Other:

Ethnicity *

White British/Irish

White Other

Asian/Asian British

Black/Black British

Mixed (multiple ethnicity)

Other ethnic group

Prefer not to say

Do you have a disability or long-term health condition? *

Yes

If you answered 'yes' to the above question, please provide details.

On average, how many days a week do you do 30 minutes or more of physical activity which is enough to raise your breathing rate?

5 days or more

Clear selection

How did you hear about Step Change Studios

Photography/video – I give permission for Step Change Studios to use photos/videos from dance that I participate in for publicity (including social media). This will be used to help engage more dance participants and supporters. *

Yes

I understand that I am voluntarily participating in a dance class with Step Change Studios that will involve movement and physical activity. It is my responsibility to consult with a doctor regarding my participation. By selecting 'yes' to this statement, I am agreeing not hold Step Change Studios responsible for any injury or property damage that I may suffer as a result of my participation in any activity in connection with Step Change Studios. *

Yes

Name of parent/guardian if participant is under 18 or lacks capacity to consent.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms