Clone of RMSEL Afterschool Circus Club Registration

Afterschool Circus Club Registration

Spoon Circus is excited to be bringing our inclusive circus programming to Paonia! Join us to learn classic circus and flow arts skills like juggling, hula-hooping, poi spinning and so much more! Our programming is accessibly designed for all, and all will find a moment of success with our trained coaches who double as Colorado local professional circus artists themselves! Programming Dates: January 16th, 23rd, 30th 4-6pm Location: Blue Sage Center for the Arts
Student Information
Students Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Do you have another student to register in the same family?*

YesNo
Students Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Do you have another student to register in the same family?

YesNo
Students Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Do you have another student to register in the same family?

YesNo
Students Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Parent/Guardian Information
Name*

First NameLast Name
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E-mail*
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Additional Emergency Information
Emergency Contact's Name*

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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.
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Spoon Circus ProgrammingFull four weeks.

$120.00 Quantity

January 16th only

$40.00 Quantity

January 23rd only

$40.00 Quantity

January 30th only

$40.00 Quantity

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Afterschool Circus Club Registration

Student Information