EmailMe Form - 2022 SA Symphony Youth Concert Reservation Form

Name of School *

Contact Person *

First Last

Principal Name *

First Last

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Please select your preferred time *

10:00am

12:30pm

Either

# of students attending *

# of adults attending *

# of wheelchair bound

# of visually impaired

# of hearing impaired

# of other special seating

Please complete the following information regarding the students participating in the Youth Concert

Students attending the Youth Concert are cleared to be photographed, recorded, or interviewed during the performance. *

YES - All students are cleared

NO - Not all students are cleared

If you marked NO for the previous question, please fill this section out.

Please list the names of the students not approved to be photographed, recorded, or interviewed.

Balcony & Floor Seating *

YES - my school can be seated upstairs

NO - My School cannot be seating upstairs

This venue offers both balcony and floor seating. THE BALCONY IS ONLY ACCESSIBLE BY STAIRS; NO ELEVATOR IS AVAILABLE.

The deadline to submit your school's registration form is FRIDAY, DECEMBER 3, 2021 *

I understand that I must submit this form in order for my school to receive the Youth Concert Curriculum Packet

Principal/Director electronic signature