Dance Intimacy Consent Form
Please complete this form to share your preferences and consent for partnered dance activities.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How would you describe your dance experience?
*
Beginner
Intermediate
Advanced
Which types of dance are you comfortable participating in?
*
Ballroom
Latin
Contact Improvisation
Blues
Other
Are you comfortable with close embrace or physical contact during partnered dance?
*
Yes, with anyone
Yes, with selected partners only
No, I prefer to maintain space
Please specify any boundaries or preferences regarding physical contact during dance.
Do you have any allergies or medical conditions we should be aware of?
Signature
*
Submit Consent
Submit Consent
Should be Empty: