EmailMe Form - Event Order Form

Your Name *

Child's Name

Event Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Location *

Email *

Contact Phone Number *

### - ### - ####

Number of Children: *

Event Date and Time: *

MM / DD / YYYY HH : MM AM/PM

Language Choice: *

Fairy tale Choice: *

How did you hear about us *

Media Disclosure *

I give permission to Puppet Theater on Wheels to take pictures and/or videotape the performance. I also give permission to Puppet Theater on Wheels to use this footage for advertising/media purposes.

I give permission to Puppet Theater on Wheels to take pictures and or/videotape the performance. I DO NOT give Puppet Theater on Wheels permission to use the footage for advertising/media purposes.

I DO NOT give Puppet Theater on Wheels permission to take photos and/or video during the performance.