Waiver Form

Which Venue would you like to enrol into? *

Please choose which venue you would prefer to enrol into classes.

Plymstock (Hooe Primary Academy)

Plympton (Valley Road)

Happy with either!

Which classes would you like to register for? *

Acrobatic Dance

Musical Theatre

Aerial Skills - Including Aerial Silk/Sling/Hoop/ Trapeze.

Circus Skills - Including Juggling, Hula Hooping, Poi & Ribbon Dance

Dance & Exam Prep 6+ - Including Ballet, Contemporary, Lyrical, Jazz & Modern

Student/Participant Name *

If enrolling a child, please enter the child's name. If enrolling yourself, enter your own name.

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent Name *

If enrolling yourself, please type N/A in this section

First Name

Last Name

Phone *

(###)

###

####

Emergency Contact *

For safeguarding and legal reasons, you must provide a separate emergency contact who is not the same as the primary contact and is aged 18 or over (e.g. other parent, partner, grandparent, sibling, trusted friend or guardian.)

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Terms & Conditions *

Please note you are about to read and sign documents that could affect your legal rights. Please read all the information carefully and ensure all information is submitted accurately.

Participation in any Vixen Dance & Circus class or event, whether in-person or online, involves inherent risks of injury or property loss. By submitting this form, I freely accept and assume all such risks for myself/my child and agree to release and hold harmless Vixen Dance & Circus and Bella Statton from any liability for loss, damage, injury or expense, including any claim arising from negligence.

I voluntarily agree to release Vixen Dance & Circus and Bella Statton from any and all liability for any loss, damage, injury or expense that I, my child, next of kin, successors or dependants may suffer or incur as a result of participation in any class, whether in person or online, due to any cause, including negligence on the part of Vixen Dance & Circus or Bella Statton.

I understand that Vixen Dance & Circus and Bella Statton will not assume responsibility for any lost or stolen property or for any bodily or personal injury arising out of participation in physical training.

By ticking this box, I confirm I have read and agree to all the above Terms & Conditions and the Waiver.

Photography & Videography *

Vixen Dance & Circus may take photos or videos during classes, shows and specific events for promotional purposes (e.g. website, social media). Consent can be changed at any time by contacting Bella Statton. Please select your preference:

I consent to photos/videos for all uses, including social media

I consent to photos/videos but NOT for social media

I do NOT consent to any photos or videos

Physical Contact and First Aid Consent *

For safety, instructors may need to provide physical support (spotting) or administer first aid in an emergency. Please select your consent:

I consent to safe spotting during training

I consent to emergency first aid if needed

I do NOT consent to spotting (I understand this may limit participation in some skills)

I do NOT consent to emergency first aid

Company Policies, Code of Conduct & Terms & Conditions *

Please read and agree to our company policies, code of conduct, safeguarding policy, and full terms and conditions before submitting this form. These outline important details about: - Class behaviour expectations - Safe participation requirements - Payment, fees, and refund policies - Attendance and notice for withdrawal - Privacy and data protection (GDPR) - Use of photos and videos You can read our full policies via our policy page or alternatively by requesting a copy by email.

By checking this box, I confirm I have read, understood, and agree to abide by all company policies, code of conduct, safeguarding policy, and full terms & conditions.

Signature & Agreement *

Please read the following statements. By checking this box, I confirm:

I acknowledge that this checkbox and submission are the legal equivalent of my handwritten signature.

I confirm I will not claim in the future that my electronic signature is not legally binding or enforceable.

I acknowledge that I have read, understood and voluntarily agree to be bound by all the policies, terms & conditions, and waivers in this agreement.

I confirm I am at least 18 years old.

If signing on behalf of a child/minor, I confirm I am their parent or legal guardian and have full authority to sign this agreement on their behalf.

I understand that this electronic signature and agreement apply to all sections and pages of this enrolment form.