PARTICIPATION PACKAGE

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(the "Agreement")

ARTICUS PRODUCTIONS INC. & TRICITY CENTRE for CIRCUS ARTS

By completing this form, you consent to being contacted by Articus Productions Inc. & TriCity Centre for Circus Arts by email.

(This form takes approximately 45 minutes to fill out.)

Email *

IMPORTANT

When filling out the form below, the Participant is the STUDENT registering for the class (adult or minor). Please fill in THEIR information only when when prompted.

If you are an "Authorizing Guardian" filling out the Agreement on behalf of a minor, please fill in YOUR email address directly above and YOUR cell phone below.

Participant's First Name *

Participant's Last Name *

Participant's Date of Birth *

YYYY

Participant's Address *

Participant's City *

Participant's Province *

Participant's Postal Code *

Participant's Country *

Cell Phone *

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Email *

Emergency Contact's Relationship to Participant *

IF PARTICIPANT IS UNDER 18 YEARS OLD, PLEASE COMPLETE THE FOLLOWING SECTION

Full Name of Parent/Guardian who is Authorizing Participant's Participation in Articus Programs (the "Authorizing Guardian")

Participant & Authorizing Guardian are hereinafter jointly and severally referred to as "Participants"

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