WAIVER

Primary Account Information

Family Last Name

Primary Phone

Emergency Phone (must be different from primary)

Date of Birth (Adult that is signing this waiver)

Month

Day

Year

How did you hear about us?

What brings you to MSA?

How many minors will you be signing for?

(Any additional participants that are 18 years or older must submit a separate waiver.)

Student Information (under 18)

Waiver of Liability

Note: if the participant has any limitations or allergies that we need to be aware of, you are responsible to communicate that in writing to info@msacircusarts.org prior program start date.

I accept the Waiver of Liability and have read and agree to the Gym Rules linked below:

1. Waiver of Liability

2. Gym Rules

I have acknowledged and am following the age requirement for the program(s) I am signing up for and I am aware of the booking and cancelation policy.

Your Signature or Guardian (if under 18)

Signature field is empty.

WAIVER

Primary Account Information

Student Information (under 18)

Waiver of Liability

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Registered Charity Number : 27-0009779