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Getting To Know Your Dancer form
Interested in enrolling in an adaptive dance class for your dancer? Please complete our “Getting To Know Your Dancer” form and we will be in touch with you!
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Your Dancer's Name (First & Last)
Your answer
Dancer's Birthdate
Your answer
Your Name (First & Last)
Your answer
Your Relationship to Dancer
Your answer
Your Email Address
Your answer
Your Phone Number
Your answer
Are you planning on using DDA Respite Funds to pay for these classes?
Yes
No
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If using DDA funds, please include contact information for DDA case Manager below.
Your answer
Explain a bit about dancer's disabilities.
Your answer
What (if any) kind of physical accommodations might your dancer need?
Your answer
What do you think your dancer will enjoy most about dance class? What might be more challenging for your dancer?
Your answer
What do you hope your dancer will gain from this class experience?
Your answer
Lastly, please share anything else you would like us to know about your dancer that will help us support them for a positive class experience.
Your answer
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