• Youth Circus Regular Class Enrolment Form 2026 - 2027

  • We require the information on this form for all Youth Circus students, including those that are returning to us. Please complete this by the 27th August 2026. Thank you for your co-operation.

  • Your Child(rens) Details

  • Child 1 Date of Birth*
     - -
  • Child 2 Date of Birth*
     - -
  • Child 3 Date of Birth*
     - -

  • Emergency Contact Details

    We will list the named parent/carer on this form as the Primary Emergency Contact.
  • Format: 00000 000 000.

  •  Please provide a Secondary Emergency Contact below:

  • Format: 00000 000 000.

  • Health & Safety

    You will need to fill out a separate health & safety form for each child attending. Please ensure you are filling in the correct information for each child (their names are automatically filled in at the top of the section to help you with this.

  • Child 1: {child1}

  • 0/50
  • We try our best to make our classes as accessible as possible and understand that some children may need some additional support to engage in the activities at Youth Circus. To help us better support your child, please let us know if they identify with any of the following:

  • 0/50

  • Child 2: {child2}

  • We try our best to make our classes as accessible as possible and understand that some children may need some additional support to engage in the activities at Youth Circus. To help us better support your child, please let us know if they identify with any of the following:

  • 0/50

  • Child 3: {child3}

  • We try our best to make our classes as accessible as possible and understand that some children may need some additional support to engage in the activities at Youth Circus. To help us better support your child, please let us know if they identify with any of the following:

  • 0/50

  • We are committed to providing individual support for all our participants, in order to facilitate a creative, inclusive and safe environment.Information given is strictly confidential and will be used only to ensure your needs are met.

  • Youth Circus Collection

    As part of our commitment to safeguarding, we will use the emergency contact details given in this form as the authorised people to collect your child. If there is someone else collecting your child - other than the designated authorised people, our teachers will ask them to provide a authorisation word/phrase to collect your child. Please create an authorisation word/phrase which you can share with your within your networks and remember to make a log of this!

  • Leaving Circomedia Unaccompanied

     

    The safety of our students is our highest priority, including when leaving site at the end of class. However, we also understand that many children are mature enough to leave site without adult collection.


    Parents/Carers may give permission for students to leave the Circomedia site unaccompanied at the end of sessions. Please note, if you select this option for your child to leave site unsupervised, you acknowledge that Circomedia's duty of care has finished, and your child is leaving as an unaccompanied minor. 

  • Unsupervised Departure:*

  • Photography Permissions

    Occasionally Circomedia may take photos and/or videos of sessions, showcases or special events for marketing and other purposes. Please let us know if you'd like your child to be included, and how you'd like us to use images and footages.
  • I give permission for Circomedia to take & use photographic & filmed images of my child(ren) for:*

  • The above consents will apply throughout the world and for an indefinite period unless we are informed otherwise. We will never identify your child by name.

  • Youth Circus Contact Permissions

    We send regular newsletters containing relevant information for parents and carers ( upcoming rebooking information, showcase information, YC news and celebrations etc). Although you can opt out, we highly recommend receiving these newsletters to ensure you are up to date with Youth Circus activity.
  • Please select your contact preferences*

  • Payments

    We use Go Cardless for all payments for Youth Circus. If you a new customer, you will need to create an account to authorise us to set up a Direct Debit.

  • All customers are set up on a Direct Debit when joining Youth Circus, securing your child’s place and spreading costs monthly. Plans available:

    10 months (Sept–June)

    6 months (Jan–June)

    3 months (Apr–June).

    If you are joining half-way through a term, we will take a one-off payment for the remaining sessions in that term, you will then be signed up the next Direct Debit plan.

    Please refer to our Terms & Conditions which include our prices and payment plans 

    We will set up all Direct Debits within one month of the revelant start date. 

  • I am happy for Circomedia to set me up on a Direct Debit (via Go Cardless) to make monthly payment for Youth Circus:*

  • Please let us know if you are returning customer with an existing Go Cardless Account*
  • Please let us know if you are eligible for our concession rate*
  • We are small charity; any extra contributions are muchly appreciated and allows us to offer bursaries and improve our services. Please let us know if you like to sign up to our donation top-up service alongside your Direct Debit*

  • Youth Circus Terms & Conditions

    By sending your child to Youth Circus you are agreeing to our Terms & Conditions which can be found on our website.
  • Please accept our payment Terms & Conditions:*
  • Please accept our Youth Circus Terms & Conditions:*

  • Equal Opportunities Monitoring

  • Circomedia wants to meet the aims and commitments set out in its equality policy and build an accurate picture of Circomedia Youth Circus.

    We need your help and co-operation to enable us to do this, but filling in this form is voluntary.

    All information provided is confidential and is stored separately to your information above.
    Please answer on behalf of your child(ren).

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