Youth Circus Access Programme

This programme offersfully-subsidised places to young people who would otherwise struggle to attend Circomedia Youth Circus. Thanks to generous sponsorship from our partners, we are able to make a limited number of bursary places available for the academic year 2017-18.

Bursaries are open for anyone to apply, however priority will be given to young people living in Ashley, Easton and Lawrence Hill wards in low-income households.

Please complete this form with as much information – all information provided is taken in good faith and stored securely and confidentially.

The bursary provides access to:

  • Regular after-school sessions
  • Specialist one-off sessions in flying trapeze, cloud swing, Chinese pole
  • Participation inYouth Circus performances

To apply on behalf of a young person, parents / guardiansshould complete the form below and return to Circomedia:

By email:

By post: C/o Robin Peters, Circomedia St Pauls Church, Portland Square, Bristol BS2 9XB

Participant / full name / D.O.B.
Parent/Carer / full name
Phone / Mob / Home
Email / N.B. all YC communication is via email - If you do not have access to email please let us know
Address / Postcode
Bursary request / e.g. 1 term/ 6 months/ full year

Youth Circus Access Programme

Application Form

1.Experience / Please tell us about any after-school clubs, sports or dance activities the young person has experience of. If the young person has taken part in a Circomedia or other circus workshop, let us know here.
2. Why Circomedia Youth Circus? / Please tell us why you think this young person deserves a bursary place on Circomedia Youth Circus.
3. Household income / What isthe combined income for the household this young person is a part of. If the young person is the member of more than one household, please give both figures here.

PARENT / CARER CONSENT

To the best of my knowledge, all of the information I have provided is true. I understand that any false information given may result in being disqualified from the bursary scheme.

SIGN: / PRINT:
DATE:

Equal Opportunities Monitoring Form

Circomediawants to meet the aims and commitments set out in its equality policy and build an accurate picture of the make-up of Circomedia Youth Circus.

We need your help and co-operation to enable us to do this, but filling in this form is voluntary.

The information you provide will stay confidential, and be stored securely and limited to only some staff in the Circomedia Youth Circus management team.

Please answer on behalf of the young person you are applying for.

Gender Male  Female  Non-binaryPrefer not to say If you prefer to use your own term, please specify here …………………….

What is your ethnicity?

Please tick the appropriate box

White

English  Welsh  Scottish  Northern Irish  Irish

British  Gypsy or Irish Traveller  Prefer not to say 

Any other white background, please write in:

Mixed/multiple ethnic groups

White and Black CaribbeanWhite and Black African  White and Asian 

Prefer not to say 

Any other mixed background, please write in:

Asian/Asian British

Indian  Pakistani  Bangladeshi  Chinese  Prefer not to say 

Any other Asian background, please write in:

Black/ African/ Caribbean/ Black British

African  Caribbean Prefer not to say 

Any other Black/African/Caribbean background, please write in:

Other ethnic group

ArabPrefer not to say  Any other ethnic group, please write in:

Do you consider yourself to have a disability or health condition?

YesNo  Prefer not to say 

If you would like assistance completing this form, or would like to access it in a different format, please contact the classes team on or call +44 (0) 1179 247 615.