205 intake form

Please fill out to the best of your abilities and sign the statement at the bottom. If you have any questions, please feel free to ask.

Name *
Name
Phone *
Phone
Please indicate if you suffer from any of the following ailments…
*Please note that if you have had botox or any other form of injectables in the last 48 hours, you are not allowed to participate in any of the aerial lessons at Studio 205. I the undersigned, do hereby certify that i have completed the above information and know it to be truthful and accurate to the best of my knowledge.
 
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