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New Student Information

First Name

Last Name

Address

Email

Phone

Today's Date

Date of your Personal Lesson:

Time of you Personal Lesson

How would you classify your dance at this present time?

How did you hear about us?

Please mark the dances/dance styles listed below that youwould like to learn:

Ballroom

Social

Latin

Slow / Smooth

Country Western

Bachata

Cha Cha

Mambo

Merengue

Rumba

Salsa

Samba

Hustle

Lindy Hop

Night Club 2 Step

Swing

West Coast Swing

Foxtrot

Waltz

Argentine Tango

Tango

2-Step

Shuffle

Polka

Other

Are you learning for a special occasion?

If yes, what is the occasion:

Date of occasion:

How would you like to look on the dance floor?

How many times a week do you feel you can come in until you reach your goal?

Which days are best for you to schedule personal dance lessons?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Which times of day are best for you to schedule personal dance lessons?

Morning

Afternoon

Evening

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