Name: A Look Behind the Scenes June 24th – 28th
SKU: 192655
Price: 150.00 USD
Availability: InStock

Description

Students will learn about various elements of theatre that go into every production!

June 24th – 28th Monday – Friday | 9am – 12pm

Ages 7-22

Registration Information
Registrant First Name *
Registrant Last Name *
School District *
Age *
T-Shirt Size *
Diagnosis (Check all that apply)	ADD/ADHA Angelman Syndrome Anxiety Disorder Apraxia Autism Spectrum Cerebral Palsy Down Syndrome Dysphagia Epilepsy Fragile X Syndrome Hearing Impairment OCD ODD Spina Bifida Traumatic Brain Injury Vision Impairment Other No Known Diagnosis
If other please explain
Describe the participants means of communication	Verbal-easily understood Verbal-understood with some interpretation Verbal-requires interpretation Non-verbal Speaks a language other than English Uses Sign Language Uses gestures/pointing Uses communication device
Describe the performer’s reading.	Does not read Dyslexic Reads a language other an English Reads below grade level Reads at grade level Other
Describes participant’s ability with gross/fine motor skills.	Needs support when walking Walks slowly Unsteady when walking Uses braces Needs support when jumping Needs support when running Needs support when climbing stairs Uses a walker Uses a manual wheelchair Uses an electric wheelchair No assistance needed in this area
Does the participant have a history of seizures?	Yes No
Does the participant have any allergies we need to be aware of?	Yes No
If yes please list allergies below
Please list all medications the participant is taking.
Will the performer need to bring any medications to rehearsals such as an inhaler, EpiPen, etc.?
Are there any additional medical concerns we should be aware of?
Describe participant’s behavior in social settings	Withdrawn Shy Reserved Interactive Dominating
What are some behaviors the participant might struggle with?	None Bad language Crying/screaming Hiding/running away Refusing to move Refusing to participate Spitting Undressing Other
Please Describe
How are these behaviors dealt with at home or in school?*
How can we assist with these behaviors during rehearsals?	Offering quiet space Offering choices Speaking calmly and quietly Using fewer words Give break time Provide pressure Provide sensory stimulation Use first/then statements
Please describe any fears or sensitivities the performer may have and how they react to them.
Is there any other information that would be helpful for us to know?
We are unable to accommodate participates that pose a physical harm to themselves or others. Please do not enroll your child if they exhibit these behaviors.
Participation Goals
What made you want to register the participant for this program?
What is the participant most excited about doing/ achieving from our program?
What is the participant’s goal for the program?
Is there anything else related to the participant and musical theatre that we should know?
Please exclude my students photos from being used on Social Media and promotional materials.
Emergency Contact Information
Emergency Contact Name *
Emergency Contact Number *
By checking this box I agree to the terms outlined in the Participation Agreement *

A Look Behind the Scenes June 24th – 28th

Registration Information

Participation Goals

Emergency Contact Information

Description

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