Dance/USA Freelance Dancer Screening Registration

Dance/USA Freelance Dancer Screening Registration Form

(Please complete one form per screening event of freelance dancers)
The purpose of the Dance/USA Freelance Dance Screen is to provide education and information to the freelance/independent dancer. The organizer should not keep any collected information as this constitutes private health information. If you are interested in research and/or collection of data, you must obtain approval of an Institutional Review Board. Dance/USA is able to provide resources and examples if needed. Any presentation of data collected

1. Contract Year: *This question is required.

2. Healthcare Professional Name: *This question is required.

3. Credentials: *This question is required.

4. Address:

5. Phone: *This question is required.

6. E-mail address: *This question is required. This question requires a valid email address.

7. Screen Date: *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

8. Location of the screen: *This question is required.

9. Intended population: *This question is required.

10. Research interest *This question is required.

11. Is this screening event in combination with a day of dancer health or with a local Dance USA chapter? *This question is required.

No
Yes - A day of dance health
Yes - A local Dance USA Chapter
Other - Write In (Required)