WBDC Adaptive Dance Program Questionnaire

Hello! We are so excited to have your dancer participate in WBDC’s Adaptive Dance Program! Please fill out the below questionnaire to help learn a little more about your dancer. We can’t wait to meet everyone!

Dancer's Name

First Name

Last Name

Please describe the dancer's disability as identified in an IEP or physician diagnosis.

Will your dancer participate in class with any needed accessories? (Examples: wheelchair, hearing aids, leg braces, etc.)

Please choose any that apply to your dancer.

Sensitive to rough textures/fabrics

Allergic to perfurmes/dyes/smells

Sensitive to bright lights

Sensitive to strobing/active lights

Bothered by surprising loud sounds

Problems staying on task/staying focused

Runs away from group or persons in charge

Minimal help needed

Is there anything else you would like to share with us about your dancer to help us get to know them and prepare the best class experience?