Broward County Public Schools - Broward Center for the Performing ...

2009-2010 Application Form
FOR STUDENT PERFORMANCES AND SEAS PLUS
Each performance must have a separate application. Please make copies as needed
and pony completed forms to: Denyse Murguia, K.C. Wright Building – 12th Floor
Incomplete forms will be returned and possibly wait listed.
All applications will be considered on a first come, first served basis.
Applications MUST be received via inter-school pony mail or direct mail. Phone calls or faxes will NOT be accepted.
Please refer to bus schedule information on pages 53 and 54.
n Theater Performance n In-School Performance/SEAS-On-Tour n Special Evening Event n SEAS Plus
PERFORMANCE TITLE _______________________________________________________________________________________
1st Date Choice _____________________________________________________________________________________________
2nd Date Choice ____________________________________________________________________________________________
Name of School _____________________________________________________________________________________________
School Phone Number _______________________________________________________________________________________
Contact Person _____________________________________________________________________________________________
Email Address ______________________________________________________________________________________________
Principal’s Signature __________________________________________________________________________________________
TOTAL SEATS REQUESTED:
(This total includes students, teachers and chaperones)
SEAS PLUS REQUESTS
Please check your choices
for student attendance below:
FOR THIS PERFORMANCE ONLY, PLEASE LIST
NUMBERS OF THE FOLLOWING (no percentages):
(required by State of Florida for grant reports)
Black _____ White _____ Hispanic _____ Other _____
Do you or your students have any special accessibility needs?
No _____ Yes _____
LIST NUMBERS OF THE FOLLOWING:
Wheel Chair _____ Hearing Impaired _____
Vision Impaired _____ Easy Access Seating (no stairs) _____
Other (specify) ________________________________________
LOCATION
n Museum of Art
n Stranahan House
n Fort Lauderdale History Center
n Museum of Discovery & Science
CAPACITY
200 students
65 students
100 students
100 students
Will you bring an oral interpreter with your hearing impaired students?
No _____ Yes _____
Grade Level(s) Attending _________________________________
All shows, dates, actors and times subject to change without notice.
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