Name *

First Name

Last Name

How old are you?

7-9 y/o

10-11 y/o

12-13 y/o

14-15 y/o

16+ y/o

How long have you been dancing for?

1-2 years

2-3 years

3-4 years

5+ years

How many hours a week do you technique classes?

0

1-2 hours

2-3 hours

3-4 hours

5+ hours

How many Coup'e raises can you do? (calf raises on one leg)

0-5

5-10

10-15

15-20

20-30

How long can you balance on relieve for?

0-5 sec

5-10 sec

10-20 sec

20-30 sec

30 + sec

How long can you balance on FLAT for?

20-30 sec

30 -40 sec

40-50 sec

1 min

1-2 min

When you pointe your feet, are your toes in line with your heel?

Yes

Not

Almost

Not sure

Have you rolled or sprained your ankle in the last year?

Yes

No

Do you currently have any foot or ankle pain?

Yes

No