Participant Intake Form

Name of Student *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Gender *

Male

Female

Non Binary

or another gender

Participant pronouns *

What would you like to be called when we don't use your name?

He/Him

She/Her

They/Them

It

Ze

Home or Mobile Number in case of emergency *

Country

(###)

###

####

How did you hear about us? *

Google

2FD Website

Word of Mouth

Social Media

Flyer

Other

Do you give us permission to take photos or videos that may feature you or your child for marketing or archive purposes? *

Yes

No

Which Class Have you signed up for? *

Kin Project

Wee Movers

Mega Movers

Teen Contemporary

Adult Contemporary Advanced

Adult Contemporary Beginners