FlyTeam Application 2019
First Name of Applicant *
Your answer
Last name of Applicant *
Your answer
Mailing Address *
Your answer
City/State or City/Province *
Your answer
Zip Code or Postal Code *
Your answer
Country *
Your answer
Primary phone *
Your answer
Secondary phone
Your answer
Email *
Your answer
Age *
If you are not yet 18 yrs old, please provide contact information for Parent/Guardian
Full name, relationship, email & telephone number
Your answer
Please indicate your flying trapeze training, and any other athletic, movement and/or circus training (if any). *
Your answer
Please tell us why you would like to attend NECCA's FlyTeam Program and what you hope to accomplish. *
Your answer
Other Information
Please indicate below how you found out about the FlyTeam Program at NECCA. *
Check all that apply.
Required
If you are accepted who will pay for your program fees? *
Check all that apply.
Required
If you selected either "a family member" or "other" to the last question, please provide the name, telephone number and email address for the person paying for the program.
Your answer
Health & Medical Information
Who would we contact in case of an emergency? *
Name, phone number & relationship to student
Your answer
Do you currently suffer from any medical conditions? *
If you selected "yes", please explain.
Your answer
Do you suffer from allergies (ie seafood, nuts)? *
If you selected "yes", please explain.
Your answer
Do you travel with an emergency kit or other preventative measure? *
If you selected "yes", please explain.
Your answer
Do you regularly take any medication(s)? *
If yes, please list medications.
Your answer
Please indicate any past or current health issues or injuries that may affect you during this program. *
If none please answer "no" in the field below.
Your answer
I understand that I will be required to show proof of health insurance in order to participate in NECCA's FlyTeam Program. *
Video application
Please submit your 2 minute video of yourself swinging out of lines, executing a turn around, and any other skills you wish including other flying trapeze skills, tumbling, and trampoline. If you are interested in catching please show yourself making and getting out of a lock. Please submit though YouTube or Vimeo. Do not make the video password protected so that anyone with the link can view it. P lease title it with your first & last name.
Please copy the link to your online audition video here. *
Please do not submit your application without a video link.
Your answer
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This form was created inside of New England Center for Circus Arts.