First and last name of contact person

Email address

Phone number

Municipality

I request coaching

for myself

for my theatre company

Date of birth

Municipality

Is this request made in the context of a production?

Yes

No

Titel voorstelling

Namely:

Coach selection

I ask OPENDOEK to find a coach

I propose a coach myself

Name of the coach

Email address of the coach

Phone number of the coach

What would you like to learn from this coaching?

Name of the theatre company

Municipality

Is this request made in the context of a production?

Yes

No

Title of the performance

How many people will be coached? Please specify the number per age category

Under 26 years old	26–55 years old	55 years and older

Namely:

Coach selection

I ask OPENDOEK to find a coach

I propose a coach myself

Name of the coach

Email address of the coach

Phone number of the coach

What would you like to learn from this coaching?

Total number of hours

This is a minimum of 2 hours. The maximum is 12 hours per theme for groups and 4 hours for individuals

Provide as many dates and times as possible on which the coaching could take place.

This makes it easier to find a suitable coach. The final dates will be determined in consultation with a coach.

Place and address where the coaching will take place

Place and address

Venue name

Street and number

Municipality/City

Postcode

Other remarks

Coaching application form

Place and address where the coaching will take place