Adult Acro Intensive Registration Form
In order to secure your place in the workshops - please complete the below form and finalise payment. Thank You!
Participant Information
Participant Full Name: *
Your answer
Participants Gender: *
Participant Age *
Your answer
Participants Birthdate: *
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Choose your Workshops
PLEASE NOTE: ONLY WORKSHOPS WITH AVAILABLE SPACES ARE SHOWN
Adult Acro Intensive $25 per session or 2 sessions for $40
Please select one or more workshop/s from the list
Medical Information
Medical Issues: *
Required
Emergency Contact Name: *
Your answer
Relationship to Participant: *
Your answer
Emergency Contact Number: *
Your answer
Billing Information
Billing Contact Name: *
Your answer
Email: *
All correspondence will be sent to this address.
Your answer
Billing Contact Phone: *
Your answer
Street Address: *
Number & Street
Your answer
Suburb: *
Your answer
State: *
Your answer
Postcode: *
Your answer
Where did you hear about our holiday workshops? *
Required
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 understand that the classes may be photographed by the WA Circus School for archival purposes but may also be used for marketing purposes. I agree to indemnify and release the WA Circus School and their trainers for 2018 from today until 31 January 2019.
Required
Signed: *
Please enter your full name.
Your answer
Date: *
Please enter today's date.
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Concession Terms & Conditions
To qualify for concession, you must either scan a copy of your concession card and email to info@circuswa.com or take a photo and text to 0421 605 253
How will you be paying? *
Payment Information
PRE-PAYMENT IS REQUIRED TO SECURE YOUR PLACE IN THE WORKSHOPS.

Bank Account Details

WA Circus School
BSB: 082-356
Account Number: 945 991 368
Bank: NAB

Please leave your child's full name or family surname as a
reference and where possible send us a receipt of payment.

WE PREFER PAYMENT VIA BANK TRANSFER
however where this is not possible you can make a payment
via credit card. Please give us a call on 0435 374 492 or 0421 605 253

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