Circus Workshop - Circus Kidz Registration and Waiver Form

Circus Workshop

Registration Form & Waiver

Workshop Location*

e.g. Casula Library

Child 1 - Full Name*

First NameLast Name

Child 1 - Date of Birth*

Date

Child 2 (if applicable) - Full Name

First NameLast Name

Child 2 - Date of Birth

Date

Please specify any allergies and/or medical conditions

e.g. Asthma

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 'Circus Workshop' at the chosen location.
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 workshop.

I agree and consent to all of the above*

Please tick

Signature*

Date

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*

Date