The Paramount Theater of Charlottesville - Arts Education Supplemental Information

Arts Education Supplemental Information

School Name(Required)

Order Number(Required)

Please enter the order number from your email confirmation.

Show Requested(Required)

Enter show(s) title & time in the field below. You must fill out one Supplemental Information form for each order submitted.

Grade Level of Students Attending Performance(Required)

Number of Students Attending Performance(Required)

Number of Teachers/Adult Chaperones Attending Performance(Required)

A maximum of 1 adult for 10 students and a minimum of 1 adult for 20 students is required. Home school families may have 1 adult per household in attendance. If your group requires additional supervision, please note in Special Needs section.

If you or your students require any accessibility or special needs accommodations, please indicate below.

Please specify number of students, special accommodation needs, and show(s)/date(s). Types of requests may include wheelchair, sight or hearing impairment, ASL interpreter (must be requested at least 4 weeks prior to show date).

Teacher/Field Trip Coordinator Contact Name(Required)

Teacher/Field Trip Coordinator Phone (School)(Required)

Teacher/Field Trip Coordinator Cell Number

Teacher/Field Trip Coordinator Email(Required)

Note: Public and private schools please use your school division email address.

Enter Email Confirm Email

Attending Lead Teacher Name (If different than School Contact)

First Last

Attending Lead Teacher Email(Required)

School Type(Required)

School District/County/City(Required)

School Address(Required)