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Winter 2017 School Holiday Workshop Registration
In order to secure your place in the workshops - please complete the form below and finalise payment. Thank You!
Participant Information
Child's Full Name:
Your answer
Child's Gender:
Child's Birthdate:
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Choose your Workshops
5 - 7 YEAR OLD GROUP | $75.00 per 3 day program
8 - 12 YEAR OLD GROUP | $75.00 per 3 day program
13+ YEARS GROUP - $75.00 per 3 day program
Medical Information
Medical Issues:
Required
Emergency Contact Name:
Your answer
Relationship to Participant:
Your answer
Emergency Contact Number:
Your answer
Billing Information
Billing Contact Name:
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Email:
All correspondence will be sent to this address.
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Billing Contact Phone:
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Postcode:
Your answer
Where did you hear about our holiday workshops?
Required
Indemnity Agreement
Indemnity Agreement 2017
I indemnify and release the WA Circus School and their trainers against all costs incurred, expenses and all liabilities whatsoever arising as a result of the Participant’s actions or trainer instructions during all activities undertaken within the WA Circus School training space and any performances in collaboration with the WA Circus School that may arise. I understand that the Participant must follow safety instructions and guidelines for using equipment as the WA Circus School does not accept liability for personal injury. I understand that the WA Circus School strives to ensure that a high level of safety is maintained at all times. I understand that the Participant voluntarily participates in any activities undertaken with the WA Circus School. I authorise the WA Circus School to seek appropriate medical attention in the event that the Participant is injured. I understand that the classes may be photographed by the WA Circus School for archival purposes but may also be used for marketing purposes. I agree to indemnify and release the WA Circus School and their trainers for 2017 from today until 31st December 2017.
Required
Signed:
Please enter your full name.
Your answer
Date:
Please enter today's date.
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How will you be paying?
Payment Information
PRE-PAYMENT IS REQUIRED TO SECURE YOUR PLACE IN THE WORKSHOPS.

Bank Account Details

WA Circus School
BSB: 082-356
Account Number: 945 991 368
Bank: NAB

Please leave your child's full name or family surname as a
reference and where possible send us a receipt of payment.

WE PREFER PAYMENT VIA BANK TRANSFER
however where this is not possible you can make a payment
via credit card. Please give us a call on (08) 9335 5370

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