Rhythm India Bollywood and Indian Dance School - Classes in Sugar Land Houston Katy
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"Jhoom" Fitness Questionnaire
Please fill out this form to help us better understand & support your fitness goals
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Indicates required field
Name
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First
Last
Sex
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Male
Female
Please select from drop down box
Date of Birth
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Phone Number
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Email
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Address
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Current Weight
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Goal Weight
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Please indicate your personal fitness goals (Please select all that apply)
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Lose weight
Improve flexibility
Improve stamina
Build muscle
Improve diet
Get toned
What does your exercise routine consist of?
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How many days per week do you exercise?
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Are you currently enrolled in any Rhythm India Classes? If so please list them
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How many Jhoom Fitness Classes are you willing to attend per week?
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1
2
3
Please select from drop down box
What dance styles are you interested in? (Select all that apply)
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Bollywood
Belly Dance
Hip Hop
Bhangra
Salsa
Which days / times would you be likely to attend? (Select all that apply)
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Monday Evening
Tuesday Evening
Wednesday Evening
Thursday Evening
Friday Evening
Sunday Morning
Sunday Evening
Please list any prior or existing health concerns
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Please list any other comments, concerns or requests
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