Are you filling out this form for yourself or someone you care for?

Myself

Someone else

A group

Student Name *

First Name

Last Name

Have you participated in Circus Kumarani's programs before?

Yes

No

Do you/your group have any disabilities or impairments?

Yes

No

Do you have access to reliable internet/technology to attend online classes?

Yes

No

How would you like to join us? (check all that apply) *

Learning through zoom classes

Connecting through our facebook group

Email newsletters with activities, challenges, video workshop links