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MSA & Circus arts

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WAIVER

Primary Account Information

Family Last Name*

Email*

Primary Phone*

Emergency Phone*

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

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

1. Waiver of Liability

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)*

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1934 N Campbell Ave

Chicago IL

60647

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Offerings

Recreational Circus Arts Classes

Pre-professional Specialty Classes

Professional Act Development

Camps and Intensives

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Registered Charity Number : 27-0009779

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