YOUR BRAIN EXPLAINED

Your Brain Explained

Booking Form
Confirmation of Details
School or college name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Teacher name*
Email
example@example.com
Telephone contact number
Monday 20 November AMMonday 4 December AMMonday 11 December AMMonday 20 November PMMonday 27 November PMMonday 4 December PMMonday 11 December PM
FOR PERFORMANCES ONLY Please breakdown timings for the day. We will require 1 hour to set up and can arrive anytime after 9.30 am. The performance is 1.15 hrs long and we will require 45 minutes to strike the set.
Yes, onsiteYes, nearbyNo
If yes, please describe
Required Info for Workshop

Please note: When inflated our 'brain dome' is 6 x 3.6 x 2.7m (L/D/H) so a tall, large space (i.e school hall) will be needed to accommodate the performance.
Please describe your performance space (School hall, theatre)*
YesNo
If yes, please describe
YesNo
If yes, please describe
YesNo
Additional elements
PLEASE NOTE:

The performance is appropriate for ages 11-25 and we can come to any secondary school or youth organisation. As this is a performance, we can perform to as many students as your venue allows.
Please state the age range of your students.*
For the performance we are looking specifically to work with students who receive the pupil premium grant, require SEN or additional support and who have social, emotional and mental health (SEMH) needs, and who have limited access to cultural experiences. Please explain here how the performance would meet the needs of your students.
DATA PROTECTION CONSENT

THEATRE FOR LIFE would like to take photographs or video the group for promotional purposes. These images and video footage may be sent out to the media with a press release, to our funding providers or used for our publications or on our website and social media forums.

Note: if consent is not given, THEATRE FOR LIFE will not use any images taken during the activity that contains group members.
YESNO
DECLARATION

I have provided information to the best of my knowledge to help the Theatre for Life enrich and support our student needs.

I will ensure that all SEN and disability needs are met by providing a qualified staff member to support the students needs during the performance.

I will ensure that staff members are present during the performance to maintain the correct ratio of students to adults.

I will ensure that any classroom management is suitably dealt with by a qualified staff members and will not expect the Theatre for Life team to discipline students.

I will ensure that any accidents are reported in the accident book and a form has been completed for both parties to sign.

I will ensure that the space and facilities are suitable for the performance and that I have liaised with Theatre for Life about any technical requirements.
Signature
Date
Should be Empty:

Your Brain Explained

Confirmation of Details

Required Info for Workshop

Additional elements

PLEASE NOTE: