Accommodations Request Form

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Please complete this form to request accommodations.

Applicant preferred name: *

Applicant first and last name: *

Name of an adult (if requesting accomodation for a minor): *

Preferred telephone number: *

Preferred email address: *

Confirm email address: *

We will be in touch with you at least 72 hours prior to the perforamnce. What is your prefered form of contact? *

Phone

Text

Accomodation/s requested (Check all that apply) *

Curbside assistance

Early seating

Wheelchair seating

Aisle seats with moveable armrests (also called transfer seats)

Seating near the exit

Bariatric seating

Service dog seating

Assisted Hearing Devices:

Sensory bins/fidget toys

Standing room

Cozy area for children

Ear plugs/Cancelation noise headphones

Content warnig(s) or potential trigger warning(s)

Print version of playbill

Digital version of playbill prior to performance

Large print digital version of playbill prior to performance

Oxygen Generator power outlet

TTY use (you can/should dial 711 at our venue)

Free or reduced odor/scent seating

Other:

Required

Performance Date Selection(s): *

Total Ellipse, Saturday, September 18th at 1:00PM (Jeanné Wagner Theater, SLC)

Fill In The Blank, Saturday, January 29th at 1:00 PM (Regent Street Black Box at Eccles Theater, SLC)

Lo And Behold, Saturday, April 30th at 1:00PM (Mid-Valley Performing Arts Center, Taylorsville)

Required

Please share any additional information that will help us better meet your access needs. *

Can we reach out to you after the performance to learn about your experience? *

Yes

Maybe

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