Youth Circus Consent Form — Garden City Community Circus

Participant details

First name *Please enter the participant's first name

Last name *Please enter the participant's last name

Date of birth *Please enter the participant's date of birth

Address (including postcode) *Please enter your address

Preferred pronouns

Contact details

Email address *Please enter a valid email address

Phone number of parent or carer *Please enter a contact phone number

Additional emergency phone number *Please enter an additional emergency number

Name of parent or carer *Please enter the parent or carer's name

Health and additional needs

Dietary requirements, allergies, physical disabilities or medicationThis information is kept confidential and shared only with your instructor.

Access requirements or additional needs

Code of conduct

My child and I have read and agree to comply with the Garden City Community Circus Code of Conduct *

Health and safety declaration

Yes, I have read and understood the above declaration *

Photography and video consent

I give permission for Garden City Community Circus to use photographs or videos of my child for promotional purposes.

I do not give consent for photographs or videos of my child to be used for promotional purposes.

⚠️ By submitting this form you confirm that all information provided is accurate and that you have the authority to give consent on behalf of the participant.

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Thank you!

Your consent form has been submitted. We look forward to welcoming your child to Garden City Community Circus!

Youth Circus — Consent Form

Thank you!