JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
CircEsteem Party Request Form
Thank you for your interest! Please fill out the form below.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's Name + Age they'll be turning
Your answer
Contact
Name
*
Your answer
Address
*
Your answer
Phone
*
Your answer
Number of Participants
*
Your answer
Age Range of Participants
*
Unfortunately for anyone younger than 5 we can't guarantee participation in the skills
5-6yo
6-7yo
7-8yo
8-9yo
9-10yo
10-11yo
11-12yo
12-13yo
13-14yo
14-15yo
15-18yo
Other:
Required
Date(s) Requested
*
Parties can be booked on Saturdays after 2pm and Sundays all day, subject to availability.
Your answer
Time of Day Preferred
*
Please choose at least two possibilities.
10 am-12pm
11 am-1 pm
12 pm-2 pm
1 pm-3 pm
2 pm-4 pm
3 pm-5 pm
4 pm-6pm
5 pm-7 pm
Required
Large Circus Skill Offerings
*
Please choose 2 options.
Trapeze (unavailable at your residence)
Gym Wheel (Subject to instructor availability)
Tight Wire
Stilts (only available for groups of 20 or less)
Rola Bola
Rolling Globe
Mini-Trampoline (Subject to instructor availability)
Aerial Silks (or knot)
Lyra
Partner Acrobatics
Required
Small Circus Skill Offerings
*
Please Choose 2 Skills
Juggling
Feather Balancing
Clowning
Diabolo
Spinning Plates
Hula Hoop (Subject to instructor availability)
Required
Take Away Gifts! Let your guests take the circus home!
CircEsteem T-Shirt $15
Peacock Feather $2
Clown Nose $2
Juggling Balls $15 (set of 3)
Other:
Would you like us to provide the food?
We have party deals with Papa Ray's Pizza and Tesfa Ethiopian Cafe that we'd love to offer you, depending on your number of guests. Let us know if you're interested!
Yes! Tell me more!
Unsure
No, thank you
How did you hear about us?
*
Google Search
Referral
CircEsteem Brochure
School Flyer
Winter or Spring Circus
Kidwinks
Chicago Parent
Other:
Required
Do you have any other requests, questions, comments, or specifications?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of CircEsteem.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report