Contact person First Name Last Name Email * School name Date MM DD YYYY Time Hour Minute Second AM PM Number of students Please precise the total number of students as well as the number of students of each grade Preferred skits (pick 2-3): Attention Deficit Hyperactivity Disorder (ADHD) Autism Cerebral Palsy Hearing Impaired Person Down Syndrome / Developmental Disability Emotional Behavioural Learning Disability Spina Bifida Visual Impairment Additional details Do you wish to have a specific disability emphasised? Are you integrating students with disabilities? Thank you! Book your performance