Request edit access
Margaret River Circus School Booking Form
Sign in to Google to save your progress. Learn more
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 *
Which class would you like to book your kid into?
Descriptions and prices of each class can be found at  facebook.com/margaretrivercircusschool
If any doubts please don't hesitate to contact us prior to booking
What previous experience does your child have (if any)? 
(eg Gymnastics, dance, acro, other circus classes)  
Emergency Contact Details
Name *
Phone *
Relation to student *
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 in this section both times. 
Photo consent *
I give consent to use 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’ 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
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms