New Member Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Please indicate if your child has any of the following conditions that might affect their ability to participate in fast dancing and acrobatics (tick all that apply):

Heart conditions (e.g., congenital heart disease, arrhythmia)

Asthma or severe respiratory conditions

Epilepsy or other seizure disorders

Muscular dystrophy or other muscular disorders

Bone disorders (e.g., osteogenesis imperfecta, brittle bone disease)

Joint disorders (e.g., juvenile arthritis, hypermobility syndrome)

Severe scoliosis or other spine-related conditions

Balance disorders (e.g., vertigo)

Severe anemia or other blood disorders

Diabetes (type 1) with complications

Severe vision impairments

Hearing impairments

None

Other:

Phone Number

Country

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