Indemnity Form

We are very much looking forward to hosting your family here at Flipside Circus at the upcoming workshop. We take safety seriously at Flipside Circus and ask that you please indicate your permission for your child to participate in the circus workshop by completing this online form.

Name of the workshop/school?*

Parent or guardian contact details

Name*

First name Last name

Email*

Phone*

Suburb*

Number of individuals attending the workshop*

Circus Participant 1

Participant Name*

First Last

Date Of Birth*

Participant 1: Medical Details

Do 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 limitations

Circus Participant 2

Participant Name*

First Last

Date Of Birth*

Participant 2 Medical Details

Do 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 limitations

Circus Participant 3

Participant Name*

First Last

Date Of Birth*

Participant 3 Medical Details

Do 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 limitations

Circus Participant 4

Participant Name

First Last

Date Of Birth

Participant 4 Medical Details

Do 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 limitations

Marketing Consent

Flipside Circus may take and use video or photographic images of their classes for promotional and documentation purposes. Do you agree to consent to Circus Participant’s image being used?*

Yes
No

Would you like to receive email updates about workshops, performances and circus related opportunities?*

Yes
No

Workshop Waiver

By filling this form you agree to the following:

I understand that my child could be learning circus skills such as trapeze, tumbling, acrobatics, juggling, devil 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 children participating in this activity will be required to warm-up and cool-down.

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 realise my child may be performing and training using various training devices. Therefore, in consideration for allowing my child 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 my child 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 my child while training or performing at, for, or under the direction of Flipside Circus.

I hereby give permission for the Flipside Circus Staff to give the immediately necessary authority on my behalf for any medical or surgical treatment recommended by competent medical authorities for my child, 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.

Date

Name of parent*

Please type your full name in the signature panel. This acts as a binding agreement.

WELCOME TO FLIPSIDE CIRCUS

Indemnity Form

Parent or guardian contact details

Circus Participant 1

Participant 1: Medical Details

Circus Participant 2

Participant 2 Medical Details

Circus Participant 3

Participant 3 Medical Details

Circus Participant 4

Participant 4 Medical Details

Marketing Consent

Workshop Waiver

FLIPSIDE CIRCUS