Application Form for:

THE ART & JOY OF HOSPITAL CLOWNING
FALL 2008 WORKSHOP

WORKSHOP DATE: October 25 & 26, 2008
APPLICATION DEADLINE: September 1, 2008

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Please PRINT this form, complete it and mail it to:

Hearts & Noses Hospital Clown Troupe, Inc.
Attention: Fall Training Workshop
PO Box 920570
Needham, MA 02492  

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The reason for this questionnaire is to help us in the selection process.  Space is limited so selection will be based on interests and background.  It is also to help us to get to know who you are, in order to give you the best possible learning experience.  

Name: ______________________________________________________  

Address: ____________________________________________________  

City:_________________________________________________________  

State: _____________ Zip: ____________________  

Phone: _________________________________  

What are the best times to reach you? ________________________________ 

email: __________________________________  
 
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If you are currently a hospital clown, or have been a hospital clown, please answer the questions below.


1) Where are you a Hospital Clown? Name of Hospital? Place?




2) How long have you been a hospital clown?




3) How many days a week do you clown?




4) How many hours each day do you clown?




5) What types of patients do you see, ages, illnesses?




6) Are you part of a group?




7) Do you work alone?




8) Do you work in pairs?




9) What type of clowning do you do- play on words, magic, prepared skits?




10) Do you use improvisation in your clowning?





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If you have never done Hospital Clowning, please answer the questions below.

 
1) Why would you like to take this training?




2) How do you hope to use this training in your work?




3) Is there anything else about yourself or your group that would be important for us to know in order to provide a high value clowning program? 





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Signed: ___________________________________________________ 

Date: ________________________________________________