BTR BREAKIN PRESCREEN QUESTIONAIRE

Please fill out the following form to help us BETTER serve you.

First Name (include bboy/bgirl name)

Email Address

Last Name

Date of Birth

Occupation

Breakin Experience

Dominant side/direction of movement?

Right/ Clockwise

Left/ Counter-Clockwise

Ambidextrous (both)

Mixed

Athletic Experience (sports, dance, etc)

Current training schedule / programming?

GOALS WITH BREAKIN? (SPECIFIC MOVES, LONGEVITY, ETC)

Are you currently suffering from a medical condition or injury, past or present? *

No

Yes

If you answered yes, please elaborate

Self rate your skill (disregard if you are new)

TOPROCKTOPROCK

POWER MOVESPOWER MOVES

FOOTWORKFOOTWORK

FREEZESFREEZES

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

Thanks for submitting!

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