Consent Form for CIRCUS STARSFirst Name (of young person) Surname

Address

Postcode Landline Phone

Mobile Phone Email

Date of Birth Name and address of doctor

Additional emergency contact phone number Name of parent/carer

Circus Stars is funded by BBC Children in Need and is for young people who would not normally have the chance to participate in an activity like this. This might be because the young person is from a low-income family or one-parent family, or is a young carer, etc. Can you say why this might apply to you?

Please tell us about injuries, allergies, physical disabilities or medication

Can the young person leave on their own after sessions? (Please tick one)

Yes No

For the parent/carer read and sign In the event of an emergency occurring when it is not possible to contact me or my additional

emergency contact, I authorise staff of The Circus Project to take the necessary action in the best interests of my child

I give permission for photographs of my child participating in Circus Project activities to be used for publicity purposes

I accept that some of the activities are potentially dangerous and undertake them at my own/ my child’s risk

Signed Date

For the young person to read and sign: I have read the Circus Stars Agreement and will follow them when training with The Circus

Project. I understand that circus can be dangerous if everyone doesn’t follow simple rules and I understand

that if I don’t follow the rules I might be asked to leave the project.Signed Date

01273 884732mail@thecircusproject.co.ukwww.thecircusproject.co.uk

Registered Charity No 1107838

CIRCUS STARS AGREEMENT

Training in circus, especially aerial circus, creates the possibility of injury. But if everyone sticks to the following agreement the risk is reduced hugely. We want everyone to be safe and happy – by training in the right way and feeling comfortable in the group everyone can experience success!

Behaviour Agreement

I will come to sessions with a good attitude, not distract or disrupt others and will follow the teacher's directions.

I will help and respect my class mates and never bully anyone. If the teacher feels that I am distracting my class mates or endangering myself or

others, I understand I will be asked to sit out of the session. If I am asked to sit out more than 4 times, I understand that I might loose my place on

the project completely. I agree to participate fully in all games and exercises. When waiting for my “go” on the equipment, I agree to keep noise levels down for

safety reasons. I agree to switch off phones and other electronic devices as soon as I enter the training

space.

Illness and injury I understand I can come to class with a very minor injury as long as I 1) tell the teacher

at the beginning of the session and 2) stop working if the injury seems to be getting worse.

I understand I must not come to class if I am not well.

Aerial injuries etc I understand that it t is normal for students to get bruises and rope burns when in

aerial circus training. (Wearing leotards, layers, leg warmers, socks with the toes and heels cut away, jazz boots and ankle straps may help.)

Lateness I understand that all students must warm up thoroughly before using aerial equipment,

and if I have arrived late or missed the warm up for any other reason, I might have to sit out of the class.

Clothing/DressExercise/Dance/Sports clothing is best. As you will be hanging by your knees at times, you ill be most comfortable with legs covered (so no shorts).

• No very baggy clothes• No jeans• No jewellery• No belts, scarves, buckles or clasps.• Long hair should be tied back.• Participants should work in bare feet.• No socks for games/running.• Long fingernails must be kept short. • Risks associated with wearing spectacles can be minimised by wearing flexible frames

or contact lens or ensuring glasses are secure.• Sensitivity to religious beliefs should be afforded with regard to the dress code but any

clothing that is considered by the instructor to be unsafe should be changed • No body jewellery.