Reservation Request form for Student Matinee Series showtimes What show are you reserving tickets for?(Required)Broke-ologyEmmaTeacher Name(Required)Discipline/Class(Required)School Name(Required)Grade Level(s) Attending(Required)School Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School County(Required)Email(Required) School Phone #(Required)School Fax #Mobile Phone #(Required)To be used for emergencies and/or day of show information.Are you a Title 1 School? Yes, Title 1 No Would you like to attend the post-show talk-back conversation with the cast? Yes No Unsure Choice of DatesWe will make every effort to seat your group on the requested date, but if we can’t, we will aim for one of your alternate dates. We cannot guarantee that all groups will be seated on their requested dates. Selecting only one date will reduce your likelihood of a reservation.First Choice(Required)February 18February 20February 25February 27Second Choice(Required)February 18February 20February 25February 27Third ChoiceFebruary 18February 20February 25February 27First Choice(Required)May 13May 15May 20May 21Second Choice(Required)May 13May 15May 20May 21Third ChoiceMay 13May 15May 20May 21Accessibility Requests(i.e. Accessible seating, ASL Interpreter, Braille program or other).Ticket Quantity + CostOne chaperone is free with every 10 tickets for groups with fewer than 100 students (10 student tickets + 1 free chaperone) One chaperone free with every 20 tickets for groups with over 100 students. (20 student tickets + 1 free chaperone)# of student tickets Quantity Price: $10.00 Quantity # of free chaperone tickets Quantity Price: $0.00 Quantity # of addl. chaperones Quantity Price: $10.00 Quantity Total We will contact you if all of your selected performances are sold out.Any questions or comments? Thank you! When you submit this form, a copy of your responses will be sent to your email.Further questions? Contact Melinda McCrary, Director of Education and Community Programs at mccrarym@kcrep.org or 816-235-5708.