WHO ENROLLS IN THE PROGRAM?

Thank you for your interest in the Zena Rommett Floor-Barre™ Teacher-TrainIng Certification Program. The Zena Rommett Foundation welcomes dance teachers, dancers, physical therapists, physicians, wellness professionals, and others working in movement, health, and rehabilitation who share a commitment to helping dancers, athletes, non-dancers, and older adults experience the benefits of this therapeutic and transformative Technique.

Please complete the form below to tell us about yourself, and your interest in becoming part of the Floor-Barre™ fellowship.

1. PERSONAL INFORMATION

Professional Name:
Phone Number:
Email Address:
Address:
City, State, Zip code:
Country:
Birthday (optional):

2. DANCE BACKGROUND

Have you studied dance extensively before?

YesNo

If yes, please indicate the styles you have studied:

BalletContemporaryModernJazzSalsaTapOther
Other:
Years of dance training:

Current dance level:

BeginnerIntermediateAdvancedProfessional
Please briefly describe your previous dance training or experience:

3. FLOOR-BARRE™ EXPERIENCE, IF ANY

Have you previously taken Floor-Barre™ classes?

YesNo
If yes, approximately with who and how long?

4. HEALTH & PHYSICAL CONDITIONS

Do you have any current or previous injuries, physical conditions that may affect your participation? This information will be shared with the mentors only.

NoYes
Yes ~ please explain:

5) HOW SDID YOU HEAR ABOUT THE PROGRAM?

WebsiteSocial mediaFriend/ReferralStudioAdvertisementOther
Who?
Other:

6. GOALS & EXPECTATIONS

What are your main goals for joining the Floor-Barre™ Technique course?