INDEMNITY FORM FOR ADULTSWELCOME TO FLIPSIDE CIRCUS We are very much looking forward to welcoming you at Flipside Circus at the upcoming workshop. We take safety seriously at Flipside Circus and ask you to please complete the following form. Adult Indemnity Form We are very much looking forward to welcoming you at Flipside Circus at the upcoming workshop. We take safety seriously at Flipside Circus and ask you to please complete the following form. Date of workshop attending* DD slash MM slash YYYY Name of workshop* Circus Participant DetailsName* First name Last name Email* Phone*Date Of Birth* DD slash MM slash YYYY Suburb* Emergency contact name* Emergency contact phone*Participant Medical DetailsDo you have any relevant limitations or medical conditions that impact your ability to exercise that Flipside Circus needs to consider?* Yes No Please outline these limitationsMarketing ConsentFlipside Circus may take and use video or photographic images of their classes for promotional and documentation purposes. Do you agree to consent to participant's image being taken?* Yes No Would you like to receive email updates about workshops, performances and circus related opportunities?* Yes No Workshop WaiverBy filling this form you agree to the following: I understand that I could be learning circus skills such as trapeze, tumbling, acrobatics, juggling, spin sticks, hula hoops, etc. There will be experienced trainers teaching the workshops. All these skills involve physical exertion. Flipside Circus always encourages and highlights the need for correct warm-ups and cool-downs. All people participating in this activity will be required to warm-up and cool-down. ACKNOWLEDGMENT OF RISK AND WAIVER OF LIABILITY I recognise that potentially severe injuries, including sprains, strains, broken bones, permanent paralysis or death, can occur in any activity involving height or motion or juggling. I UNDERSTAND AND ACCEPT THAT RISK I also realize I may be performing and training using various training devices. I further understand that while the payment of tuition and registration fees constitutes a part of the consideration due to Flipside Circus for allowing me to use the facilities and equipment of Flipside Circus, an additional and important part of the consideration due to Flipside Circus is this signed release form. Therefore, in consideration for you to use Flipside Circus’s equipment and facilities, I hereby forever release Flipside Circus, its management committee, officers, employees, trainers, and coaches from all liability for any and all damage and injuries suffered by me while under the instruction, supervision or control of Flipside Circus, its management committee, officers, employees, teachers or coaches. I hereby agree to individually protect for the possible future medical expenses which may be incurred as a result of any injury sustained by me while training or performing at, for, or under the direction of Flipside Circus. EMERGENCY MEDICAL TREATMENT CONSENT It may be essential at some time for the Flipside Circus Head Trainer/Trainer/Administrator to have the necessary authority to obtain any urgent medical treatment which may be required whilst at performance or training. I hereby give permission for the Flipside Circus Head Trainer/Trainer/Administrator to give the immediately necessary authority on my behalf for any medical or surgical treatment recommended by competent medical authorities for me, where it would be contrary to my interest, in the doctor's medical opinion, if for any reason I cannot give my personal consent. This acknowledgment of risk, waiver of liability and emergency medical consent form, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent. * I have read the above information and agree to the terms and conditions of Flipside Circus.