The Big Retreat - Aerial Workshops Waiver

Cirque de Silk LTD

www.cirquedesilk.com

info@cirquedesilk.com

By completing this form, you consent to the processing of your personal data for the specific purpose of booking a workshop through Cirque de Silk LTD, The Big Retreat Festival.

All the information given on this form is treated confidentially and it is stored securely. We will not share any of your information with any third parties.

Please update us immediately if any of the information below changes before your

workshop.

Please do not take part in the workshop if;

1. You are currently unwell, including with flu, fever, gastrointestinal illness, or any other contagious condition.

2. You have an injury, medical condition, or physical limitation that may be aggravated by exercise or aerial activity.

3. You have been advised by a medical professional not to participate in physical activity.

4. You are pregnant or may be pregnant, unless you have obtained medical clearance to participate.

Full name

Contact Mobile Number (Please put parent's number if U18 years)

Emergency Contact Name

Emergency Contact Number

Relationship to you

Have you practised aerial before?

Yes

Please read the questions carefully and answer each question honestly:

	Yes	No
Has your doctor ever said that you have a heart condition or high blood pressure?
Do you feel pain in your chest when you do physical activity?
Do you lose balance because of dizziness or have you lost consciousness in the last 12 months?
Do you have a bone or joint problem that could be made worse by becoming more physically active? (For example back, knee, shoulder or hip)
Do you have any chronic illness or physical limitations such as asthma, diabetes?
Are you pregnant now or have you given birth within the last 6 months?
Have you had recent surgery?
Has your doctor ever said you should only do medically supervised physical activity?
Is your doctor currently prescribing you drugs or medication?
Do you know of any other reason why you should not do physical activity?

If marked YES to any of the above, please elaborate below:

It is your responsibility to inform us of any physical or mental health conditions, injuries, or medical concerns (past or present) that may affect your ability to safely participate in physical activity. Please include any relevant details below.

Are you happy for photos to be taken during the workshop? Images and videos may be used for for promotional material on our social media or website.

Yes

Would you like to be added to our mailing list?

Yes

I confirm that I will not participate in the aerial workshop while under the influence of alcohol, drugs, or any other substance that may impair my ability to participate safely. Participants who appear to be under the influence may be refused participation and asked to leave. I confirm that the information given is a true and accurate statement. I understand that if I have declared any of the conditions listed, further information may be requested. I acknowledge that participation in aerial silk and aerial hoop workshops involves inherent risks, including the possibility of serious injury. By accepting these Terms and Conditions, I confirm that I understand and voluntarily accept these risks and agree to follow all safety instructions and guidance provided by the instructors and organisers at all times.

Signature