Black Box Theater Reservation Request Form
MPTCS - 125 Sussex Avenue - Newark, NJ 07102 - E: - P: 973-621-0060 Ext.2013
For external organizations, networks, and establishments, please fill in the highlighted chart fields.
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Name (First and Last Name) *
E-Mail *
Which campus site is requesting space in the Black Box Theater?
Date of Event (please provide 1-2 alternative dates) *
Start Time
End Time
Please list your Audio and Visual needs, instruments, and special request(s).
How many attendees are you expecting?
Please describe the Scope of the Event.
If tickets are being sold, please list the cost of admission.
Do you need parking accommodations?
For External Organizations, Networks, and Establishments
Please list the name of your organization.
Type of Organization
Business Telephone Number:
EIN Number:
Name of Organization's Contact:
Phone Number
E-Mail Address
Do you have required insurance coverage in the amount of $100,000/$300,000?
Thank you for submitting this request! You will receive a response from the Office of the Superintendent/CEO within 24 hours of submission. For immediate assistance, please e-mail: or call 973-621-0060, Ext. 2013.
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This form was created inside of Marion P Thomas Charter School.