SPECIALIST PROGRAMS
Come and join in to any one of these classes for the last few weeks of term, $15 per class. Come to one or come to all!
Participant Information
Participant's Name: *
First Name & Surname
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Participant's Gender: *
Participant's Birthdate: *
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Class/es enrolling into:
Medical Issues: *
Required
Emergency Contact Name: *
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Relationship to Participant: *
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Emergency Contact Number/s: *
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Billing Information
PAY ON ARRIVAL OF FIRST CLASS $94 FOR FOUR SESSIONS
Billing Contact Name: *
*Enter parent/gurdian if participant is under 18 years of age.
Your answer
Billing Contact Gender: *
Email: *
All correspondence will be sent to this address.
Your answer
Billing Contact Phone: *
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Billing Address: *
Street / Suburb / State / Postcode
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Indemnity Agreement
Indemnity Agreement 2018 *
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 agree to indemnify and release the WA Circus School and their trainers for 2018 from today until 31st December 2018.
Required
Photography Agreement 2018 *
I understand that the classes may be photographed by the WA Circus School for archival and marketing purposes. I agree to photos of myself/my child being used for the above stated purposes.
Required
Signed: *
Please enter your full name.
Your answer
Date: *
Please enter today's date.
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And one last question... How did you hear about us? *
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