Thank you for your interest in scheduling a COUNT ME IN puppet show at your elementary school! You must enter all contact information (Question 1) in order to submit this form. If you are unsure about how to complete any other questions on the form, you can leave them blank and we will discuss with you when we follow-up on your request. If you have any questions, call PACER at 952.838.9000 or email puppets@pacer.org. Thank you!

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* 1. Please provide your contact information:

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* 2. Please provide billing name and address. Cost is $100 per show.

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* 3. How many COUNT ME IN disability awareness shows are you requesting? (Maximum of 3 shows can be presented in 1 day.)

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* 4. For each show, list grade level and number of students and adults per show. (Maximum of 80 first graders or 100 2nd-4th graders per show.)

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* 5. Please provide some information about the site and room where the show(s) will be held. (Room should be quiet, large enough to seat students on the floor in front of our puppet stage, and available 30 minutes ahead of first show for set-up.)

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* 6. Please list your preferences for date and time of show(s).

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* 7. Informational letters in English are provided for the students to take home following the presentation. Please check if you would like the letter in any of the following additional languages for you to make copies for your students:

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* 8. Any additional information or special requests?

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