Independent Health Foundation's Fitness for Kids Challenge

BRAIN FREEZE PRODUCTION

Please fill out the form below to gather more information about your school's performance.

Date(s) of show(s) requested

Time(s) of show(s) requested

School Name

School Address

School phone number

Contact Person Name

Cellphone Number

Would someone from your school like to introduce the production?

Performance Location

	Gym		Auditorium		Classroom
	Other

Power outlet near performance area?

How many students?

What are the grade levels of the students attending?

How will the students be seated?

	on floor		on chairs		bleachers
	other

Where should Theatre of Youth staff park?

What entrance should be used for unloading/loading equipment?

Where can actors/actresses get dressed?

Any additional information about your school, questions or concerns?