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General Questions/Inquiries
First Lesson Form
Downtown Sarasota
941.955.8558
Lakewood Ranch
941.907.8183
General Interest/Questions
Full Name
*
Please type your full name.
E-mail
*
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Phone
*
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I would like to schedule an introductory lesson at:
Downtown Sarasota
Lakewood Ranch
Venice
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Message/Question
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Submit
First Lesson Form
If you have scheduled your first lesson,
please complete the following form.
Primary Contact Name
*
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Primary Contact Email
*
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Primary Contact Phone
*
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What is the location of your first lesson?
*
[Choose One]
Downtown Sarasota
Lakewood Ranch
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What is date and time of your first lesson?
*
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If you know who your instructor is, please select
[Choose One]
Sarah
Maks
Bella
Chuck
Evie
Colton
Madyson
Vova
Sasha
Chanel
Michele
Meridith
Kiersten
Iya
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Gentleman's Info
Gentleman's Name
Please type your full name.
Gentleman's Home Phone
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Gentleman's Work phone
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Gentleman's Mobile Phone
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Gentleman's Email
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Gentleman's Birthday (mm/dd)
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I am
Under 21
21 Years or Over
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Lady's Info
Lady's Name
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Lady's Home Phone
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Lady's Work Phone
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Lady's Mobile Phone
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Lady's Email
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Lady's Birthday (mm/dd)
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I am
Under 21
21 Years or Over
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Address
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City
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State
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Zip
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Anniversary (mm/dd)
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Preferred method for confirmation of lesson
Phone
Email
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May we send e-mails of upcoming events?
Yes
No
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How did you hear about us?
I won a lesson at an event
In the yellow pages
I found you online
I received a postcard
I saw your sign
A friend referred me
I saw you newspaper ad
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I was referred by:
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Have you ever had lessons before?
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If yes, where and for how long?
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Are you preparing for a particular event?
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Date of event
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Additional Comments
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What are your area(s) of interest?
Smooth
Standard
Rhythm
Latin
Tango
Salsa
Swing/Jive
Merengue
Cha Cha
Waltz
Samba
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Types of activities in which you would like to be involved?
Social Dance Lessons
Weekly Social Parties
Competitions
Dinner Dances
Weekend Getaways
Weekly Social Parties
Vacations w/ Dance Shows
Local Events
Dance Shows
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Where do you envision yourself enjoying Ballroom Dancing?
Night Clubs
Competitions
Live Music Venues
Cocktail Lounges
Weddings
Formal Events
Restaurants
Other
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What interests you most about taking dance lessons?
Fun/Excitement
Stress Relief
Social Interaction
Exercise
New Interest
Creative Outlet
Personal Development
Improvement in Health
Enhanced Confidence
Glamour
Shared Hobby
Other
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I understand that dance can result in injuries, including but not limited to falls, bruises, or broken bones. I agree not to sue, file lawsuit, or attempt to hold Dynasty Dance Clubs liable for any injuries that may be sustained on the Introductory Lesson, and that I shall be liable for all legal costs incurred by Dynasty Dance Clubs.
*
Yes
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Submit
