Registration - The Ballet Physio

Username *

Email *

First Name *

Last Name *

Password *

Confirm Password *

Dancer's First Name *

Dancer's Surname *

Date of Birth *

Age *

Dance School *

Grade / Equivalent level *

How many hours of dance per week? *

How many years have you been dancing? *

Who is your dance teacher?

Past or present injury history *

Medical history, Allergies, Medication, Scan results *

Permission to use photographs for marketing purposes

Please indicate your awareness that online classes will be recorded and will be made available to class participants via your Ballet Physio Portal *

Disclaimer – it is the dancer's responsibility to provide a safe environment in which to complete online classes. *