Partner Request form

Routine or Workshop

• Name of the Routine or Workshop name & date*
  

Your Info

• First Name *
  
  Last Name *
  
  Email *
  

  Gender*

  • Male
  • Female
  Home Phone
  
  Work Phone
  
  Mobile Phone
  

Compatibility

• Age
  
  Height
  
  Weight
  
  City and Suburb
  

Dance experience

• How long have you been dancing Modern Jive
  
  Venues you dance at regularly
  
  List any recent Routines or Workshops you've done
  
  Any further info you would like to include
  

Further Info for Routines only

• Are you prepared to do additional practise outside of rehearsals

  • Yes
  • No
  If so how often would you want to practise with your partner
  

Security

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