Jhoom Fitness Questionnaire

Rhythm India Bollywood and Indian Dance School - Classes in Sugar Land Houston Katy

"Jhoom" Fitness Questionnaire

Please fill out this form to help us better understand & support your fitness goals

* Indicates required field

Name *

First

Last

Sex *

Please select from drop down box

Date of Birth *

Phone Number *

Email *

Address *

Current Weight *

Goal Weight *

Please indicate your personal fitness goals (Please select all that apply) *

Lose weight Improve flexibility Improve stamina Build muscle Improve diet Get toned

What does your exercise routine consist of? *

How many days per week do you exercise? *

Are you currently enrolled in any Rhythm India Classes? If so please list them *

How many Jhoom Fitness Classes are you willing to attend per week? *

Please select from drop down box

What dance styles are you interested in? (Select all that apply) *

Bollywood Belly Dance Hip Hop Bhangra Salsa

Which days / times would you be likely to attend? (Select all that apply) *

Monday Evening Tuesday Evening Wednesday Evening Thursday Evening Friday Evening Sunday Morning Sunday Evening

Please list any prior or existing health concerns *

Please list any other comments, concerns or requests *

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