Request a Mojave Max Assembly

Please fill out the form in its entirety. Include your name in the "Attending Teacher Information" if you are the person responsible for completing the form, but will also have students attend the assembly.

School Information

Name of School *

Address of School*

City *	Zip Code *

Requestor's Contact Information

First Name *	Last Name *

Email *	Confirm Email

Phone *	Extension

Principal's Contact Information

First Name *	Last Name *

Email *	Confirm Email

Phone *	Extension

Office Manager's Contact Information

First Name *	Last Name *

Email *	Confirm Email

Phone *	Extension

Attending Teacher Information

Please provide the name(s) of all teachers attending the assembly and the number of students in each class. INCLUDE YOUR NAME if you are the person responsible for completing the form, but will also have students attend the assembly.

Total Number of Students

Assembly Dates

PLEASE MARK A MINIMUM OF THREE DATES THAT ARE ACCEPTABLE FOR AN ASSEMBLY. Feel free to mark as many dates as possibly that are acceptable for an assembly at your school.

Please mark a minimum of three dates.*

Thursday, September 29, 2022 Thursday, October 6, 2022 Thursday, October 13, 2022 Thursday, October 20, 2022 Thursday, October 27, 2022 Thursday, November 3, 2022 Thursday, November 10, 2022 Thursday, November 17, 2022 Thursday, December 1, 2022 Thursday, December 8, 2022 Thursday, December 15, 2022 Thursday, January 5, 2023 Thursday, January 12, 2023 Thursday, January 19, 2023 Thursday, January 26, 2023 Thursday, February 2, 2023 Thursday, February 9, 2023 Thursday, February 16, 2023 Thursday, February 23, 2023 Thursday, March 2, 2023 Thursday, March 9, 2023

Assembly Checklist

Please ensure all items have been considered and/or will be provided on the day of the assembly.

Please carefully read and check all statements.*

I have received permission from the school Principal to have a Mojave Max Assembly I understand that photos will be taken during the assembly and may be posted on Mojave Max’s social media accounts. Students participating in     the assembly should have a signed CCSD publicity form on file in the front office. It is one of the forms given to the parent or guardian at the     beginning of the school year. For those students where you’re unable to get a signed publicity form, please seat them on one side of the room to     ensure their photos will not be taken I have informed front office staff that an assembly will be taking place and the date of the assembly I have secured a multi-purpose room large enough to accommodate the assembly I have ensured that the following equipment are set up for the Mojave Max team: a projector (preferably LCD), a projector screen, a laptop     computer where the Mojave Max Assembly flash drive can be plugged in, a microphone, speakers I understand the assembly will start promptly at 9:30 AM, last for approximately one hour, and that students need to be seated in the multi-purpose room no later than 9:25 AM I have ensured the multi-purpose room is set up and available for the Mojave Max team who will arrive at 8:30 AM I understand someone from the Mojave Max team will contact me via phone to discuss assembly logistics prior to the assembly I understand that I will be receiving an assembly evaluation following the assembly

Please explain how your students would benefit from a Mojave Max assembly.*