Application for Community Visits and Performances

We welcome visitors and performers from our community to spend time with our patients and families through our programming activities in our Child Life Program.

Name of Group/Individual

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Main Contact Person:

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Address:

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Email:

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Phone Number:

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Yes

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Visit Information:

Performances: Please provide a brief description of your planned performance, including target age of the audience. For example: Musical duo performing pop songs on piano and guitar that are appropriate for
children of all ages and their families.

Activity/Event: We ask all groups to come with an activity for patients and families when they visit. The more information you can provide, the better we can advertise it to families and generate interest and participation in your event. For example: We will bring materials to make paper flower chains and birdhouses made from milk cartons.

Are you interested in providing a performance or facilitating an event/activity?

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Performance Event/Activity

Brief Description of Your Planned Activity or Performance:

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Please list at least three choices of dates and times that your group is available to come, and we will check our schedule to see if there is availability during one of those times.

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How much time prior to the event would you need to set up?

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Number of visitors or performers in group (including chaperones):

Most groups have an average of 15-25 performers. If your group exceeds 25, we will have to
determine if we are able to accommodate your group in our performance space.

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Age Range of Group Members:
**If your group plans to have interaction with patients before or after the performance (i.e., a meet
and greet or interactive demonstration or activity), all members must be 16 years of age or older.

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Does your performance or event require any hospital equipment? Please specify below:

(ie- tables, chairs, speakers, microphones)

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Does your event include any Costumed Mascot Characters?
We only allow experienced and professional costumed characters to perform at our hospital.

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Yes

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Please confirm that you have read our Community Group Visitor and Performer Guidelines:
Click here for guidelines: Community Group Visitor and Performer Guidelines

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Yes

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