CCCF Performer Registration | CentralCoastCirqueFest

Performer First name

Performer Last name

Performer Date of Birth

Month

Day

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Email

Emergency Contact Name

Emergency Contact Phone Number

Relationship To Competitor

Circus School

Coach Name

Coach Email

Coach Phone Number

List ANY unusual set up requirements for any of your acts. Please list if you have large props, unusual rigging, unusual mat needs or large storage requirements. List anything that may inconvenience the flow of the competition.

Parent/Guardian info (required for participants under 18)

Parent phone # if different than above

Parent email address if different than above

I HAVE READ AND AGREE TO THE FOLLOWING STATEMENT: Injury/Risk Assumption

PARTICIPANT/ PARENT OR LEGAL GUARDIAN VIDEO/PICTURE RELEASE AGREEMENT: I understand that my childs picture or video may be used for promotion of CCCF through its website and promotional materials. I understand that if requested, the video or picture will be removed immediately. I will not hold CCCF liable for any issues that arise due to this imagery being used.

PARENT OR LEGAL GUARDIAN NOTIFICATION OF MEDICAL CONDITION(S) OF CHILD STATEMENT So that we may be aware of any and all possible medical and/or behavioral issues that your child may experience, please list below.

I HAVE PROVIDED COMPLETE INFORMATION TO THE BEST OF MY KNOWLEDGE

Date

Month

Day

Year

Additional Performance

Additional Novice - Solo$130

Additional Student/Advanced Student/Emerging Pro - Solo$130

Additional Student/Advanced Student/Emerging Pro- Duo (Per Person)$100

Additional Student/Advanced Student/Emerging Pro- Trio (Per Person)$80

Additional Student/Advanced Student/Emerging Pro- Quad (Per Person)$70

Please select one additional performance per additional act.

First Act

Other Apparatus

Second Act

Other Apparatus

Third Act

Other Apparatus

Performer Registration Form