Fall 2018 After-School Circus Registration Form - Fairview-Clifton German Language Elementary School


Circus Class for Grades 2-6 including unicycle
Fridays 3:45- 5:15
September 14 December 14 (no class October 5) 3:45 - 5:15 in the gym
Fee: $190 for first child, $150 for each additional sibling

Circus Fun! for Grades K &1
Fridays 3:45- 5:15
September 14 December 14 (no class October 5) 3:45 - 5:15 in the gym
Fee: $190 for first child, $150 for each additional sibling
Enrollment is limited to 6 participants.

rednose@fuse.net, 859-581-7100

I wish to sign up my child for: *
First Name *
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Last Name *
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Address *
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Address #2 if applicable
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City *
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State *
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Zip *
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Principle Cell Phone *
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Second Cell Phone *
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Birthday *
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Grade in school *
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School
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Name of Teacher *
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Shirt Size *
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Parent's First Name *
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Parent's Last Name *
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Emergency Contact *
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Emergency Cell Phone *
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Email *
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Second Email
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How did you hear about My Nose Turns Red Youth Circus
Medical Information: Does the student have any of the following conditions that we should be aware of?
Check all that apply
Have you read and signed our 2018 policies?
Have you read and signed our release? If you do not have one on file, one will be sent before classes start.
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