Event and Performance Request Form | Levine Children's Hospital

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We appreciate your interest in visiting the children at Atrium Health Levine Children’s Hospital. Please complete the following form regarding your event or performance. These will be reviewed by the Event Coordinators of Levine Children's Hospital.

We will do our best to accommodate your scheduling desires and request you to submit this form at least one month prior to your 1st choice scheduling date. Please note, we reserve the right to accept or decline a visit based on the interest of all patients.

Name of Your Group Contact Phone Number Contact Email Address Describe in detail what activity/event or performance you would like to provide. In this description, please include a description of any supplies that you will be bringing for your event as well as any gifts or handouts should you be providing these.

Yes, I acknowledge that all participants in my programming will be 16 years of age or older and program participants will have 6 people or less in our group. Yes No

Scheduling Your Program

Please provide your first, second, and third choice of dates that you would like to host an event or performance at Levine Children's Hospital.

First Choice Second Choice Third Choice

Levine Children's Hospital Event and Performance Request Form

Scheduling Your Program

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