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Alameda County <br />Safe Routes to Schools Puppet Show <br />Assembly Request Form <br />Beginning October 5, Safe Routes to Schools Alameda County will <br />be bringing "A Breath of Fresh Air," our wonderful puppet show, to schools in your area. Created and performed by the Big Tadoo <br />Puppet Crew, the 40 -minute show blends imaginative puppets and music into a fun and educational story about all of the elements of <br />the journey to school (safety, health, physical activity, discovery, decision-making). <br />The Safe Routes to School Show is for two audiences: K-2 and 3-5 graders. You can schedule one or both shows; however if you <br />bring both shows they must be held on the same date. Each show takes approximately 35-40 minutes and they are performed in <br />sequence, with a 10 minute break between shows. SPECIAL NOTE: PRIORITY BOOKING WILL BE GIVEN TO SCHOOLS <br />THAT HAVE NOT HAD THE SHOW BEFORE. <br />Please fill out the form below and choose at least three possible dates and times on Monday, Tuesday, or <br />Wednesday beginning at 9:OOAM or later. NOTE: Latest show on Wednesday is 11:00am. Show is <br />available all day on Mondays and Tuesdays. <br />Name of School(s): <br />Address of School: <br />Name of Requesting person <br />Phone: Email: <br />Date: <br />Please include contact information for person who will be helping to set up materials and space (if different from above) <br />YES! We would like to schedule the following (you can schedule one or both assemblies): <br />11 Assembly for K-2 Grades <br />Preferred Dates & Times: <br />October: <br />January: <br />❑ Assembly for 3-5 Grades <br />November: <br />February: <br />December: <br />March: <br />April: <br />Preferred Times: (Note: no earlier than 9:00a.m.; 2nd show begins 45 minutes after 1st show) <br />Times: 1. <br />2. <br />3. <br />Please return this form to: <br />Safe Routes to Schools Alameda County <br />c/o TransForm <br />436 14th Street, Suite 600 Oakland, CA 94612 <br />Fax to 510-740-3131; Voice 510-740-3150 <br />Email to SR2S@TransFormca.org <br />