2025-26 Aerial Beats Health and Liability Form 16+
Please fill out the below form before attending an Aerial Beats class or workshop. It is your responsibility to inform us if any of the information changes.
Contact Information
Name (of participant)
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Name of parent/Guardian if participant is under 18 years of age
First Name
Last Name
Phone number
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact
*
First Name
Last Name
Emergency Contact Relationship to you
*
Emergency Contact Phone Number
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Health Form
Please answer the following questions truthfully. If you answer "YES" to any question, you may be required to get medical clearance before participating in classes.
Do you have any heart condition or have you ever had chest pain during physical activity?
*
Yes
No
Do you experience dizziness, light-headedness, or fainting during physical activity?
*
Yes
No
Do you have high blood pressure or take medication to control your blood pressure?
*
Yes
No
Have you ever been diagnosed with a joint or bone problem (e.g., arthritis, osteoporosis, or past fractures, Ehlers Danlos, Benign Joint Hypermobility) that could affect your ability to perform aerial or circus activities?
*
Yes
No
Are you currently or have you recently experienced any injuries, especially to your back, neck, shoulders, or wrists?
*
Yes
No
Do you have a respiratory condition, such as asthma, chronic obstructive pulmonary disease (COPD), or any other lung disease?
*
Yes
No
Do you have any other medical conditions or take medications that might affect your ability to perform physical activities safely?
*
Yes
No
Please provide details of any medical condition below...
Are you, or is there a possibility that you are pregnant?
*
Yes
No
Have you given birth in the past year?
*
Yes
No
Mental Wellbeing and Learning Support
Aerial and circus arts can be physically and mentally demanding. If you feel comfortable, please let us know if there’s anything that might affect your mental health, such as stress, anxiety, or any other challenges, that we should be aware of to help ensure a positive and safe experience in class.
Everyone learns differently and may have different needs in a class setting. If there's anything specific we can do to support your learning experience, whether it's a particular teaching style, pacing, or additional guidance, please let us know.
Your comfort and well-being are important to us. If there is anything that might make you feel more comfortable during the class, or if there are ways we can adapt to your needs (e.g., breaks, space, quiet time), please feel free to share
Disclaimer of Liability
Please read this form carefully. By ticking the boxes and signing the form, you confirm that you understand and accept the risks involved in participating in Aerial Beats classes, workshops and performances, and that you waive certain legal rights.
Marketing and Imagery
Terms & Conditions
Please tick to agree that you have read and understood the following
Signature
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