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DANCING FOR HEALTH - TRAINEE INSTRUCTOR ENROLMENT FORM
Select Course:
SEATED DANCE
PARTNER DANCE
BOTH SEATED & PARTNER
Full Name
Address
Tel/Mobile:
Email
Gender
Male
Female
Date of Birth:
Do you hold a dance or fitness qualification?
Yes
No
If yes, please give details of your qualifications:
Are you a health or social care professional?
Yes
No
If yes, please give details of your qualifications:
Please give details of any other relevant experience:
Do you have any injuries or pre-existing conditions, impairments or disabilities which could affect or prevent you from taking part on either the practical or theory based elements of the course?
Yes
No
If yes, please attach an appropriate Doctor’s note to confirm that you are fit and able to participate in the course.
Do you have any specific learning needs? Please tick
Dyslexia
English as a second language
Or specify below:
What is your main reason for training to be a Dancing for Health instructor?
How did you hear about the Dancing for Health Instructor training course?
Our Website
Social Media
A Dancing For Health Instructor
Word Of Mouth
Advertisement
Other (please specify)
Please Specify
Risk And Liability
I understand that in order to pass this course I need to participate in all the exercises and pass the written and practical assessments.
Full Name
Signature (Type Name)
Date
Send
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