2011 Student Matinee and School Night Application

This application is common for applying to bring your students to a 10 AM performance, a “Student Matinee,” or an evening public performance, a “School Night.”

You will notice that this year we have added some extra questions about you and your school’s commitment to integrating this experience into your class curriculum. We reserve the right to give priority to teachers and schools who have a higher commitment to theatre and cultural learning. Examples of ways to show commitment include, teacher’s participation in the Alley’s Between the Lines program, engagement of Alley Theatre teaching artists in orientation and complimentary preparation workshops at the school, lesson plan ideas that incorporate the theatrical experiences that the children will have into classroom learning activities.

*Required field(s) are indicated by an .**
* I have read How to Order Student Matinee and School Night Tickets, and I understand and agree to the terms.	For process and terms, read How to Order Student Matinee and School Night Tickets.

* Which program are you interested in?	Student Matinee School Night Both
Select Your Production and Date A Christmas Carol Student Matinee Please note: All Student Matinees start at 10 a.m. Cost is $12/ticket.
Preferred Date
Alternative Date
Second Alternative Date
Estimated Group Size	(Total number of students, teachers, and chaperones)
What are your travel arrangments?
How many adults (parents, teachers, and chaperones) are attending the Student Matinee with you?
The Seagull Student Matinee Please note: All Student Matinees start at 10 a.m. Cost is $15/ticket.
The Seagull Neuhaus Stage Tuesday, February 28th, 2012
Estimated Group Size	(Total number of students, teachers, and chaperones)
What are your travel arrangments?
How many adults (parents, teachers, and chaperones) are attending the Student Matinee with you?
School Night Please Note: All School Night performances start at 7:30 pm Cost is $11/ticket.
Dividing the Estate Hubbard Stage Thursday, October 13th, 2011
Estimated Group Size	(Total number of students, teachers, and chaperones)
What are your travel arrangments?
How many adults (parents, teachers, and chaperones) are attending the School Night Program with you?

The Toxic Avenger Hubbard Stage Thursday, January 19th, 2012
Estimated Group Size	(Total number of students, teachers, and chaperones)
What are your travel arrangments?
How many adults (parents, teachers, and chaperones) are attending the School Night Program with you?

The Seagull Neuhaus Stage Thursday, February 9th, 2012
Esitmated Group Size	(Total number of students, teachers, and chaperones)
What are your travel arrangments?
How many adults (parents, teachers, and chaperones) are attending the School Night Program with you?

Red Hubbard Stage Thursday, March 8, 2012
Esitmated Group Size	(Total number of students, teachers, and chaperones)
What are your travel arrangments?
How many adults (parents, teachers, and chaperones) are attending the School Night Program with you?

The Seafarer Hubbard Stage Thursday, April 12th, 2012
Esimated Group Size	(Total number of students, teachers, and chaperones)
What are your travel arrangments?
How many adults (parents, teachers, and chaperones) are attending the School Night Program with you?
Contact Information
* Your Name

Please indicate if you are a...	Teacher at a school Home school teacher Youth group leader PTO/PTA delegate
If not any of these, please describe your situation.

* School or Group Name
Are you the school or organization representative who will coordinate the field trip and attend with the students? * Yes No
If you are not serving as the representative, provide the name and the contact information for another who will do so.
* School or Organization Representative
* Your School or Organizaton Representatives Title of Position
* School or Group Address
* City	* State * Zip
Website
Fax Number
* Daytime Phone Number
* Alternative Phone Number
* Email Address
* Alternative Email Address
* Is this a public, private, or home school?
If this is a public school, please name the school district:
About You and Your Group Please provide us with an estimated group size and answer the questions below.
What grade levels?	(Are they all 5th grade students? Is it a mix of 9 - 12th grade?)
What type of class is participating? * (A Special Education class, students in Gifted & Talented program or part of a club?)
Have you previously attended a Student Matinee or School Night performance? *
What was the last Alley Theatre production you attended with your students?
Does your school or organization participate in other educational programs at the Alley Theatre or with other theaters, performance groups or cultural organizations? If so, please tell us how long you have been involved and describe how the collaborations benefit your students?

Without enthusiastic and stongly committed teachers, the Alley Theatre Student Matinee & School Night Program cannot succeed. Please tell us how your group or team plans to intergrate Alley Theatre plays, guides and professional development into your class or youth work.

Have you received permission from your school principal? *
Do you have any exam dates that will conflict with the Student Matinee performance?
Is your group interested in attending a Post-Show TalkBack Discussion? * What is a TalkBack Discussion?
Please select a Pre- & Post-Performance Workshop * What is a Pre- & Post-Performance Workshop?
Do any group members require special services? Check the boxes for the services that apply.
Hearing Impaired	The Alley Theatre does not provide interpreters for the student matinee performances. If you have hearing impaired students that require an interpreter, please note that this is a service your school/organization must provide. Upon your request, the Alley Theater can provide you with a script for your interpreter.
Hearing Devices
Wheelchair Seating
Other Special Services
Comments
Comments and Special Requests

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