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* 1. Name

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* 2. Age

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* 3. Email Address

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* 4. Thank you for applying! What would you like to gain from this course?

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* 5. What is your experience level with dance/healing movement?

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* 6. Do you have access to wifi and a computer?

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* 7. How did you hear about this course?

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* 8. Can you attend all six sessions? Class will be on Tuesdays from 5-6:30pm on Sept 22, Sept 29, Oct 6, Oct 13, Oct 20, and Oct 27

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