CIRCABILITY CLASS REGISTRATION FORM
Please fill out one form for each participant.
Gender (please tick)
Goal of attending class:
Any Special Needs/Medical conditions:
CLASS PAYMENT INFORMATION
Please make note of any new dates/times/payment applicable to your chosen class
Please select which class you would like to register for
Diversity Day Workshops Friday 1st December 10-11.30am $5 Thanks to Creative Communities
Transition Tuesdays, Mixed Ability Youth Circus, Tuesdays 10:30am-12pm ($15 per class)
Contemporary Circus Poi @ Ellen Melville Centre $7.50 youth/students (13 - 18 yrs), $10 Adults
Juggling @ Ellen Melville Centre $7.50 youth/students; $10 Adults
Unicycle Club Thursdays 6-7 pm $15 ($5 with own unicycle)
Funky Friday, 10.00-11.30am (Full)
Payment Regularity (please tick)
Per class ( please note that you must either bring cash to class, or pay on the day via internet banking)
Per term (to be paid in advance)
Payment Method (please tick)
Internet Banking: Circability will send an invoice.
I am part of an organisation that pays my class fees* (please list below)
*Organisation that pays my class fee (if applicable)
Circability take all due care that our classes are a safe and fun experience but learning circus skills involves risk. We all have a shared responsibility to keep ourselves and everyone else safe. By ticking the box below you agree to these conditions.
RELEASE FORM FOR USE OF PHOTOS/VIDEOS ON WEB PAGE, SOCIAL MEDIA, etc.
(We often take pictures in class)
I, being either the person pictured or legal guardian or attorney of the person/s pictured grant permission to use material captured during the course of my involvement with Circability without reservation.Please tick which applies
I give consent of release to use of pictures or moving images
I DO NOT give consent of release to use of pictures or moving images
Circability Trust, PO Box 78414, Grey Lynn, Auckland 1245 Ph 09 3613801
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