Spring Series 2023 - Interest Form

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Email *

First and Last Name of Form Submitter (you) *

First and Last Name of Participant *

Participant's Preferred Pronouns

Age of Participant *

Phone Number (in case of inclement weather) *

Has the participant previously attended class at Uprise Circus?

Yes! They have participated in a Series.

Yes! They have attended an Intro Class.

No.

Clear selection

Do you expect to be able to attend classes on these Sunday Mornings in 2023:

Feb 19 - Apr 2 (except 03/19) ?

Yes! Every Sunday!

Yes- at least half of these Sundays.

Yes- at least one or two of these Sundays.

No, but keep me in mind for future dates.

Clear selection

Which time do you prefer? *

Sundays 9:00a-11:00a

Sundays 10a-12:00a

I don't have a preference.

Required

I heard about this through... *

Life in Belterra

Flyer

Social Media

A friend (please tell us who in the box below so we can thank them!)

My school (please tell us which school below)

Other:

Required

Anything else we should know about the student? Any medical conditions? Anyone we should thank for referring you?

The person applying is (check all that apply) *

a person of color

a member of the LGBTQ+ community

living in poverty

struggling with mental health

none of these

Other:

Required

I understand that I must fill out ONE form for EACH participant I wish to enroll. *

Yes

I understand that the spot isn't secured until I receive a confirmation email from Uprise Circus.

Uprise Circus receives a higher number of applicants every season (which is great!). This means that we may or may not be able to enroll every qualifying applicant.

Yes

Clear selection

Submit

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Forms

This form was created inside of Uprise Circus.