Preschool - Circus Kidz Registration and Waiver Form

Preschool Program

Registration Form & Waiver

8 Week Course
Child's Preschool/Daycare & Suburb*
Child's Full Name*

First NameLast Name
Child's Date of Birth

DayMonthYear
Date
Please specify any allergies and/or medical conditions
Parent's Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Emergency Contact Name*
Emergency Contact Phone Number*
Circus Kidz Waiver Form:

I, (Parent's Name) ,the parent of (Child's Name) (“my child”), give permission for my child to attend the Circus Kidz 8 Week Circus Course at my child's Daycare Centre.
I understand that personal injury can and may occur to my child, and I hereby authorise Circus Kidz, or another appointed advisor, to seek and consent to emergency medical attention for my child as needed; and I further agree to be liable for and to pay all costs incurred in connection with such medical attention. I hereby release Circus Kidz, its employees, agents and volunteers, from any and all liability, claims, demands, causes of action and possible causes of action whatsoever arising out of or related to any loss, damage or injury (including death) that may be sustained by my child while participating
in this course.
I agree and consent to all of the above*

Please tick
Signature*

Clear
Date

DayMonthYear
Circus Kidz Photography Release:

I, the parent or guardian of the above named, give my unreserved permission for all still and moving images taken or recorded by or on behalf of or made available to Circus Kidz of my child/children, (“the Images”) to be used in any or all of the promotional and advertising material of Circus Kidz. The Images may be used in various media formats including online media, social media, print, newspaper, video, public displays television and electronic means of communication and in any edited form. I waive any rights and claims, present and future, to any fees or royalties or other benefits whatsoever for or in connection with the use of the Images.
Please tick*

I agree and consentI DO NOT agree
Signature*

Clear
Date

DayMonthYear
Payment Details

Cost: $120 for 8 weeks

Active and Creative Kids Vouchers accepted for children 4.5yrs and above. Please send your child's voucher and date of birth to info@circuskidz.com.au.
Payment methods: (please select)*

Bank transfer $120 (please use your child’s full name in the description).PayPal $125 (surcharge applies).Active or Creative Kids Voucher plus $20 bank transfer or cashCash (Please check with Centre Director before selecting this)
Bank Details:

Account Name: Circus Kidz
BSB: 082356
ACCOUNT: 444277617
PayPal:
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8 week Circus Kidz Course$125.00AUD

Total $0.00AUD
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