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Dance Team Members Health History and Contact Information

All NEW dance team members please copy and paste this into an e-mail and send the information to fhdance@gmail.com


Dance Team Members Health History and Contact Information:

Dancer’s Full Name:
Dancer’s Date of Birth:
Grade dancer will be in 2008 – 2009:
Dancer’s e-mail address:
Dancer’s cell phone number:
Dancer’s home phone number:
Parent name:
Parents’ daytime contact number:
Parents’ e-mail address:
Emergency name and number:
Family name and doctor:
Health card number:
List any current health problems:
List any current medications:
List any current injuries:
Do you take dance at Frank Hurt?
If no, where do you take dance classes?
School or recreation centre name and phone number:
Dance class(es) that you take:

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