Faerial
Circus School

Location *

Where would you like to enrol?

Carnarvon

Denham

Exmouth

Class Type *

Four week course starts on Tuesday 12 October 2022

Kindy Kids ($15 per child)

booked out (5 - 8 years) dont book

9–12 years ($15 per child)

13–17 years ($15 per student)

18+ adults ($20 per student)

Name of Student *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent Name/ Guardian Name

First Name

Last Name

Emergency Contact Name *

First Name

Last Name

Indemnity statement *

As a participant or parent/guardian of a participant under 18 years old, I agree to the following conditions: For participants over 18 years: I fully understand the nature of the Faerial Circus classes and as such agree to participate at my own risk, knowing and accepting that Gascoyne in May Inc will ensure that activities are carried out responsibly and with a high regard for participants safety. I agree to abide by any guidelines set out by Faerial Circus Class and to follow the instructions given by Teachers/Trainers. I also undertake to pay all medical costs which may be incurred by me and/ or by anyone as a result of my actions while participating in these workshops. I shall, on demand, indemnify and keep indemnified Gascoyne in May Inc (trading as Creality) against all reasonable costs, charges, expenses, liabilities, outgoings and payments which Gascoyne in May Inc pays, is liable to pay or sustains in any way arising from any circumstance which may occur during my attendance at the workshop program, except to the extent that such loss, damage or injury is caused by the negligent or wilful act or omission by Gascoyne in May Inc . For participants under 18 years I fully understand the nature of the Gascoyne in May Inc (trading as Creality) workshop program and give my consent for my child/children, to participate knowing and accepting that Gascoyne in May Inc ensures that activities are carried out responsibly and with a high regard to safety. I understand that I am responsible to pay all medical costs, which may occur as a result of my child’s actions to him/herself during these workshops. I also give my permission for persons authorised by Gascoyne in May Inc (trading as Creality) to seek appropriate medical aid in the event that my child is injured and is unable to make immediate contact with parent/Guardian. I shall, on demand, indemnify and keep indemnified Gascoyne in May Inc (trading as Creality) against all reasonable costs, charges, expenses, liabilities, outgoings and payments which Gascoyne in May Inc (trading as Creality) pays, is liable to pay or sustains in any way arising from any circumstance which may occur during my child’s attendance at the workshop program, except to the extent that such loss, damage or injury is caused by the negligent or wilful act or omission by Gascoyne in May Inc (trading as Creality).

I agree

Photo Release Statement *

Please check only one of the following:

I give my permission for my child’s name and/or photo to appear in Gascoyne in May Inc publications, newspaper articles, TV shows, web page, calendar and/or annual report .

I do not give permission for my child’s name and/or photo to be used in the above mentioned publications.