Exercise Referral - Group Session

1. Question 1.

Please enter your company name

2. Question 2.

What is your facility's address?

3. Question 3.

Primary contact [member of staff in charge of bookings]

4. Question 4.

What's your email address

5. Question 5.

Which class would you like to book?

Ballet Balance - Low Mobility

Ballet Balance - Moderate Mobility

Seated Exercise - Low Mobility

Seated Exercise - Moderate Mobility

6. Question 6.

How many sessions would you like to book?

7. Question 7.

Would you like to add on a tea and chat post session?

Yes

No

8. Question 8.

Will your facility provide the tea and cups?

Yes

No

9. Question 9.

How many clients would you like to take part in the session?

10. Question 10.

Please provide the approximate measurements of the space wherein the sessions will take place.

11. Question 11.

Please list three main goals for your clients [what would you like them to get out of the sessions?]

12. Question 12.

Please detail any specific, additional requirements for individuals who may take part in the dance exercise class.

13. Question 13.

Please provide us with any further comments you feel may be of use.