Boulder Country Day Winter Circus Camp Registration Form

Winter Circus Camp Registration

Spoon Circus is so excited to be partnering with Boulder Country day to offer a very special circus holiday camp! Join us to learn classic circus skills like juggling, stilt walking, plate spinning and so much more! Each participant will go home with circus crafts, a t-shirt of their own, incredible special memories and a very wide smile! Our programming is accessibly designed for all, and all will find a moment of success with our trained coaches who are Colorado local professional circus artists themselves! $150 for one week reach out for interest in financial assistance.
Student Information
Students Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
T-Shirt Size*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Students Name

First NameLast Name
Birth Date

MonthDayYear
Grade
T-Shirt Size
YesNo
Students Name

First NameLast Name
Birth Date

MonthDayYear
Grade
T-Shirt Size
YesNo
Students Name

First NameLast Name
Birth Date

MonthDayYear
Grade
T-Shirt Size
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Additional Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the student prescribed an inhaler or epipen? If yes, please explain any instructions.*
Is there anything else we should know?
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Spoon Circus during the selected camp. In exchange for the acceptance of said child’s candidacy by Spoon Circus, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Spoon Circus. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Spoon Circus, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Spoon Circus Liability Waiver
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

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Date
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Winter Circus Camp Registration

Student Information