Booking Form

MY INFORMATION

Name: (*)
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Day Phone: (*)
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Email: (*)
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My Role / Relationship to the School: (*)
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Best Way to Contact: (*)
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School / Organization Information

School / Organization Name: (*)
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Street Address: (*)
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City: (*)
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State: (*)
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Zip: (*)
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Dates Requested


Our Performance Presentation is FREE, however, schools or organizations that require travel by air or are more than a 30 minute drive from Portland, OR will be required to cover travel expenses. Travel expenses will be billed on a per school, per day basis.

If you are booking a Workshop, you will pay our set workshop fee for the option you choose, plus travel expenses. Please see our Price Sheet Thank you!
What Are You Requesting?: (*)




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Dates:
Choice 1:
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Choice 2:
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Choice 3:
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COORDINATOR INFORMATION


The Coordinator is the person who works closest with UP and OVER in coordinating all the details of the day(s). The coordinator must be part of the Host School staff, and must be a school administrator, a teacher or a counselor working closely with the administration.

We require that a counselor or licensed mental health professional, employed by the school, be available to ensure follow-up services to students if needed.
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Coordinator Name:
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Day Phone: (*)
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Email: (*)
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Best Way to Contact: (*)
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School Principal

Principal Name:
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Email: (*)
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ADDITIONAL SCHOOL/ORGANIZATION INFORMATION

Please fill out this section as thoroughly as possible. Your information helps us create the best program possible for your school or your organization.
Type of school
(High school, middle school, private, alternative, youth services, charter, community etc) (*)
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Total Number of Students at Your School (*)
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Anything you would like to tell us about your school?:
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ISSUES AND GOALS


This is where you describe to us the issues you see and the goals you hope for. (If you are filling this out for an organization, please read "organization" instead of "school" in the following questions.) Please be as complete as possible. Thanks! Please describe the social climate at the school. How do people interact with each other? How do you see your school? Have there been any recent tragic or traumatic events? What are the challenges at the school? What are the opportunities?
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Please enter this code for verification (*)
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