Pre-Exercise Form - Circus WOW

Class and workshop participants are required to fill out a Pre-Exercise Form to let the trainer know about any physical issues they may need to to take into account. It also serves as a waiver form.

Please bring this completed form to your first class, or ask for a copy when you arrive.

NOTE: This screening form does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualified medical professional. No warranty of safety should result from its use. The screening system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by Circus WOW for any loss, damage or injury that may arise from any person acting on any statement or information contained in this form.

Class/Workshop/Event attending:

Your Details

Name:
D.O.B:
Address:
Postcode:
Primary Phone:
Secondary Phone:
Work No:
Email:

Emergency Contact

Name:
Primary Phone:
Secondary Phone:
Work No:
Email:

Confirmation

In attending WOW activities, I agree to:

Notify trainers/coordinators of anything that may impact on my ability to participate safely in training, including physical injuries, medical and or psychological conditions, and to seek appropriate medical advice prior to participating.
Take full responsibility for my safe participation in Circus WOW activities. This includes training and participating at my own pace, and communicating if an activity feels unsafe, or if I feel it puts me at risk.
Have Fun, challenge myself, and develop in my own way. Performing is optional.

I understand that many circus activities involve challenge and risk, including physical and emotional.

* Please note: Circus WOW activities are run as an arts skill rather than fitness, although there may be fitness aims and outcomes.

DISCLAIMER:

I, the Participiant, agree:

To accept full responsibility and personal liability for risk, participation, and self care.
That Circus WOW, its management, trainers, employees, volunteers and associates are not liable for injuries and or damages that may occur to my person or my personal belongings when participating in WOW activities.
To refrain from consuming alcohol or other recreational substances prior to attending WOW classes, and or attending WOW classes while still under the influence of said substances.
That photos taken during classes or performances may be used for Circus WOW promotional purposes such as on Facebook, or circuswow.org.au

I have read and accept the above conditions.

I am under eighteen years of age

Parent/Guardian's Name:
I am the parent or guardian of the person named in this form, and I have read and accept the above conditions.

Your Privacy

Circus WOW is committed to protecting your privacy. The information provided in this form will only be disclosed to Circus WOW management and treated confidentially at all times.