Vortex Aerial Arts

Kids Aerial Programs
Registration & Medical Release

Please complete this form before your child's first Vortex kids class, drop-in, series, or camp session. All information is kept confidential and used only for your child's safety and care.

Program

All Vortex kids programs are for ages 8 and up. The Kids Intro to Aerial — 4-Week Sunday Series (November 8–29) enrolls in the student portal — not on this form.

The November 4-Week Sunday Series enrolls in the Vortex student portal. Your child’s place, the waiver and payment are all handled there in one go, so please don’t fill this form out for the series — it won’t reserve a spot. This form is still the right place for the Saturday drop-in and kids camp.

Go to the November series
Child's Details
Emergency Contacts
Primary Contact
Secondary Contact
Drop-Off / Pick-Up Authorization

List the people (up to 3) authorized to drop off or pick up your child. Anyone not listed will not be released with your child.

Person 1

Person 2

Person 3

Medical & Health

Please list all food, environmental, insect, or material allergies.

Please list any daily, routine, or emergency medications (e.g. EpiPen, inhaler).

Health Screening

Please answer Yes or No for your child for each of the following.

Diabetes
Chest pains brought on by physical exertion
Dizziness or fainting
A bone, joint, or muscular problem or arthritis
Asthma or other respiratory problems
Studio Acknowledgments

Please read and check both to continue.

Media & Social Consent

Do you consent to Vortex Aerial Arts photographing/filming your child for promotional and social media use?

Terms & Digital Signature

In signing this form, I, the parent/guardian of the aforementioned child, affirm that I have read this form in its entirety and have answered the questions accurately and to the best of my knowledge. I understand that all accidents will be documented and that I will be informed. I understand that if the Instructor requires further information about my child's illness or disability in order to include them in activities, I will endeavor to make sure this information is available to them. I understand that if my child fails to behave in a manner that is polite and social, they may be excluded from that particular activity at the discretion of the Instructor, and will have the opportunity to rejoin the session shortly after.

Required fields are marked with *. Questions? Email Anne at anne@vortexpolefitness.com.

Registration Received 🤸

Thank you! Your child's registration and medical release has been submitted to Vortex Aerial Arts. We look forward to seeing them in class. If anything changes, email Anne at anne@vortexpolefitness.com.

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