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How old are you?
   
 
 
 
Which dance class are you in?
 
Preschool
 
Babes
 
Junior 1
 
Junior 2
 
Junior 3
 
Intermediate 1
 
Intermediate 2
 
Intermediate 3
 
Senior 1
 
Senior 2
 
Senior 3
 
Senior 4
 
Senior 5
 
Senior 6
 
 
 
How safe do you feel during class time with the junior teacher?
 
Not very safe
 
Somewhat safe
 
Safe
 
Very safe
 
 
 
Please share any concerns you have about your personal safety when in the Junior Teacher's class.
   
 
 
 
Have you ever suffered an injury at dance while under the Junior Teacher's care?
 
Yes
 
No
 
 
 
If yes, what was this injury (Select all that apply)?
 
Strain
 
Break
 
Muscle Damage
 
Bruising
 
Other

 
 
 
How did the Junior Teacher deal with your injury?
   
 
 
 
What, of the following are you encouraged by the Junior Teacher to do (Select all that apply)?
 
Wear suitable clothing
 
Tie up your hair
 
Wear jazz shoes
 
Warmup before class

 
 
 
Does the Junior Teacher enforce any rules or policies in dance studio?
 
Yes
 
No
 
 
 
If yes, what are they?
   
 
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