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Margaret River Circus School Waiting List Form
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Student & Parent information
Student First Name *
Student Last Name *
Student Date Of Birth *
MM
/
DD
/
YYYY
Student Age *
Parent Name *
Parent e-mail *
Parent Phone Number *
Book into *
Class of interest.
Descriptions of each class can be found at www.margaretrivercircus.com
What previous experience does your child have? 
(eg Gymnastics, dance, acro, other circus classes) 
Emergency Contact Details
Name *
Phone *
Relation to student *
Other Stuff
Anything we need to know? 
Allergies, injuries, learning disabilities..
Questions/comments
e.g: Payment plans, missing classes
Discount *
Please select Yes if you are booking in siblings or one child into multiple classes.
You will need to fill in a new form for each child/extra class and select Yes at this section in both times. 
Photo consent *
To use the photographs, videos and audio taken during training, performances or other activities organized by ‘the teachers’ for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee, or other compensation shall become payable to me by reasons of such use.
Terms and Conditions *
I acknowledge and hereby assume all of the risks of participating in this activity.
It is a condition of participation that I do so at my or my child’s own risk, hence I therefore indemnify and release ‘the teachers, juniors’ and/or any person or body directly or indirectly associated with the activity, against all liability; including liability for their negligence and the negligence of others. As well as claims, demands and proceedings related with my participation in this activity.
I certify that I or my child are physically fit and have not been advised to not participate by a qualified medical professional and that there are no health-related reasons or problems which preclude my or my child’s participation in this activity. I will inform the instructor immediately if this changes. 
Required
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