Let's Play Request Form

Your Name*

First NameLast Name

Email*

example@example.com

School Name*

School Town/City*

YesNo

Creative & Artistic Development (introduce students to new skills, encourage self-expression, etc.)Social & Emotional Growth (encourage teamwork, communication and problem solving)Academic & Cognitive Development (enhance literacy skills, language development, critical thinking, etc.)Engagement & Enrichment (organize a fun, hands-on experience)

Are there any behavioral or social-emotional challenges among students that the teaching artists should be aware of?

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone*

Please enter a valid phone number.Format: (000) 000-0000.

Emergency contacts will be notified of any last-minute updates, such as delays or logistical changes.

On-Site Contact Name*

First NameLast Name

On-Site Contact Phone*

Please enter a valid phone number.Format: (000) 000-0000.

The on-site contact is the person responsible for supervising the program in the space or nearby.

Present in the program space with the teaching artistFloating between spaces and checking inNearby and available if neededNot sure

1 hour (1 session) per day: $257 per day2 hours (2 sessions) per day with single teaching artist: $310 per day2 one hour sessions per day (two teaching artists): $514 per dayNot sure

Grade Level(s)

Number of Students per Session

Up to 30

How will the grades be divided?

For example, K-2 and 3-5

Drop In: each session might have a different mix of studentsRegular Attendance Encouraged: most students will attend every session but there might be some inconsistenciesConsistent Attendance Expected: students will sign up to participate and be expected to be there

Days of the Week

Monday

Tuesday

Wednesday

Thursday

Friday

Total Days

Number of Weeks

4 week minimum commitment

Start Date

Workshop Time(s)

Program Cost (read only)

Does not include any possible material fees.

YesNoI'm not sure

Questions/Additional Information

By signing here, I acknowledge that an authorized adult will be present in or near the program space and reachable at all times. I also understand that the teaching artists are not responsible for collecting or escorting students to or from locations outside the program space.

Signature

By initialing here, I acknowledge that an authorized adult will be present in or near the program space and reachable at all times. I also understand that the teaching artists are not responsible for collecting or escorting students to or from locations outside the program space.*

Your Contact Information

School Information

Program Contacts

Let's Play Program Information