First Name Last Name Email Address Tell us about yourself and what made you curious about pole! Tell us about yourself and what made you curious about pole! Tell us about yourself and what made you curious about pole! How long have you been wanting to take pole, and what was it that finally got you to commit to taking classes? How long have you been wanting to take pole, and what was it that finally got you to commit to taking classes? How long have you been wanting to take pole, and what was it that finally got you to commit to taking classes? How are you feeling about attending classes, and what are you hoping to gain over the next four weeks? How are you feeling about attending classes, and what are you hoping to gain over the next four weeks? How are you feeling about attending classes, and what are you hoping to gain over the next four weeks? Please choose which statement best describes each of the listed areas in your life: Please choose which statement best describes each of the listed areas in your life: Strength I feel great with where I am!I feel good with where I am, but I would like to make some improvements!I’m not mad about where I am, but I believe I would be happier with improvements!Ehh, It’s probably time I make improvements!I don’t feel good about it, and I’m committed to making improvements! Please choose which statement best describes each of the listed areas in your life: FlexibilityFlexibility I feel great with where I am!I feel good with where I am, but I would like to make some improvements!I’m not mad about where I am, but I believe I would be happier with improvements!Ehh, It’s probably time I make improvements!I don’t feel good about it, and I’m committed to making improvements! Please choose which statement best describes each of the listed areas in your life: ConfidenceConfidence I feel great with where I am!I feel good with where I am, but I would like to make some improvements!I’m not mad about where I am, but I believe I would be happier with improvements!Ehh, It’s probably time I make improvements!I don’t feel good about it, and I’m committed to making improvements! Please choose which statement best describes each of the listed areas in your life: Body awareness/coordinationBody awareness/coordination I feel great with where I am!I feel good with where I am, but I would like to make some improvements!I’m not mad about where I am, but I believe I would be happier with improvements!Ehh, It’s probably time I make improvements!I don’t feel good about it, and I’m committed to making improvements! Please choose which statement best describes each of the listed areas in your life: Active lifestyle/routineActive lifestyle/routine I feel great with where I am!I feel good with where I am, but I would like to make some improvements!I’m not mad about where I am, but I believe I would be happier with improvements!Ehh, It’s probably time I make improvements!I don’t feel good about it, and I’m committed to making improvements! Please choose which statement best describes each of the listed areas in your life: Daily stress levelsDaily stress levels I feel great with where I am!I feel good with where I am, but I would like to make some improvements!I’m not mad about where I am, but I believe I would be happier with improvements!Ehh, It’s probably time I make improvements!I don’t feel good about it, and I’m committed to making improvements! Please choose which statement best describes each of the listed areas in your life: Daily energy levelsDaily energy levels I feel great with where I am!I feel good with where I am, but I would like to make some improvements!I’m not mad about where I am, but I believe I would be happier with improvements!Ehh, It’s probably time I make improvements!I don’t feel good about it, and I’m committed to making improvements! Submit
