Student PAR-Q Under 16

Student PAR-Q - Under 16

* Indicates required field

Student's Full Name *

First

Last

Name of Parent / Guardian *

Date of Birth *

Relationship to Young Person *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Gender& Pronouns *

Email *

Phone Number *

Emergency Contact *

Secondary Emergency Contact *

Emergency Contact Phone Number *

Secondary Emergency Contact Phone Number *

Please confirm that you agree to be added to Rainbow Circus' newsletter mailing list in relation to offers / events / information *

YES I'd love to know what's happening NO I do not want to be updated

Has your child ever taken part in a similar class before? *

Yes No

If they have taken part in similar classes before, please state the level of achievement *

Is there a particular skill or piece of equipment that they enjoyed the most? Is there anything they'd like Rosie or other instructors to know? *

Does your child regularly exercise? *

Yes No

What kind of exercise do they enjoy? *

What does an average week's exercise look like at the moment? *

IMPORTANT : Is there anything else we should know about your child that has not been addressed in the questions on this form? *

I confirm that I have disclosed all medical conditions to Rosie Rainbow or Rainbow Circus CIC and any instructors working for them and that, where relevant, the student will carry personal medical equipment at all times (e.g. epi-pen, inhalers, etc...) *

Yes No