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Please Complete Required Medical Form

Medical Questionnaire

Please fill out the following form for each student being registered to help us understand any physical condition.

Student Name

Parent/Guardian Email

Has there been in any hospitalizations in the last 12 months? *

No

Yes

Is your child currently suffering from a medical condition, illness, or injury? *

No

Yes

Is your child taking any medications? *

No

Yes

If you answered yes to any question, please elaborate

Parent Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Welcome to LJP!

INQUIRIES

WRITE OR CALL US IF YOU ANY QUESTIONS ABOUT MORE INFO, CLASSES, OR ENROLLMENT.

LJPDance1@gmail.com
612-521-1150

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