NECCA Summer Intensive Program 2019 Application
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 any formal athletic, movement, musical, theatrical and/or circus training (if any). *
Your answer
Tell us more about your circus training history (if any).
Your answer
What circus disciplines or apparatus appeal to you most? Do you have any training in these areas? *
Your answer
Other Information
Please indicate below how you found out about the Summer Intensive Program at NECCA. *
Check all that apply.
Required
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 Summer Intensive Program. *
Video application
Please include any fitness, sport or circus activities you are currently doing, and demonstrate as many of these core skills:

1. Forward roll & dive roll
2. Cartwheel: (both sides)
3. Handstand: against a wall or free-standing
4. Back bridge: push up from laying on ground
5. Splits: left, to straddle (center), to right
6. Pull ups: please show that your feet are not on the ground at the start/end of the skill

Please copy the link to your online audition video here. *
We currently only accept submissions made on Vimeo & Youtube. Pleae do not submit your application without a video link.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of New England Center for Circus Arts.