Name of young person *

First Name

Last Name

Does the young person identify as a different gender than that assigned at birth? *

Yes

No

Which group is the young person signing up to?

Primary school age young people should join Junior Circus, comprehensive age young people should join Youth Circus

Junior Circus 7-11yrs

Youth Circus 11-18yrs

Name of parent/carer *

First Name

Last Name

Emergency contact name 2

First Name

Last Name

Information for our funders (please tick all that apply)

Disabled or Additional Learning Needs

Living in care or care experienced

Young carer

Asylum seeker or refugee

During the course of the year we will take pictures and videos of "Eruptees" practising and performing their skills to use for publicity, newsletters, photo albums, funding reports and on our social media and website. *

I give permission for photographs and videos to be taken and used for all specified purposes

I DO NOT give permission for photographs or videos to be taken

Consent *

I consent to the named young person taking part in Circus Eruption sessions

How did you hear about Circus Eruption?

I've been before

I was at a Circus Eruption workshop somewhere else

Facebook or other social media

Word of mouth/a friend

Other