2015 APPLICATION FORM

 2015 APPLICATION FORM PROGRAM DETAILS ARTiculate is an innovative leadership in the arts program for youth ages 13-­‐18 featuring workshops with professional artists, field trips to arts destinations, a volunteer placement and a final exhibition and event. The program will run from July 6 -­‐ 24, 2015 at Lakeshore Arts, 2422 Lakeshore Blvd West, from 10:00 am -­‐ 4:00 pm Monday to Friday (except as otherwise indicated on the program itinerary, which will be provided before the start date). Past workshops and field trips included sculpture, ceramics, break dancing, stop motion animation and behind the scenes tours of the Design Exchange, Harbourfront Centre and performances at the Dream in High Park. ARTiculate registration is by application and interview. All youth who wish to participate must submit a completed application form and participate in an interview with program staff before enrollment is confirmed. Deadline for application: Friday, June 5th at 5pm For more information, please contact [email protected] or call 416-­‐201-­‐7093. PARTICIPANT INFORMATION & CONDITIONS OF ENROLLMENT To be completed by Parent/Guardian Name: ________________________________Date of Birth: ______________________ Apt. ____________ Address: ________________________________________________ Home Phone #: _________________________ Email: ________________________ School: _________________________________ Grade: ________________________ Parent/Guardian Name: ___________________________________________________ Parent/Guardian Work/Cell Phone: ___________________________________________ Parent/Guardian Email: ____________________________________________________ Alternate/Emergency Contact Name: _________________________________________ Relationship & Contact Info: ________________________________________________ Please list any dietary/medical/behavioural concerns: (attach a separate page, or call the office, in order to outline how best to ensure a positive experience for all in consideration of this concern) ________________________________________________________________________ This three-­‐week program includes at least 2 field trips downtown. On field trip days, participants can be dismissed from downtown, the subway, or Lakeshore Arts. Please indicate your choice here: o Dismissed from downtown o Dismissed at Royal York Station o Dismissed at Lakeshore Arts o Other __________________________________________ The program fee is $350.00. At Lakeshore Arts, it is our priority to provide accessible programming for youth by eliminating barriers to participation. Full and partial bursaries are available for this program. Please attach a letter of request to this application if you would like to apply for a bursary. Amount Paid: _________________________________________ Method of Payment: o Cheque enclosed (payable to Lakeshore Arts) o Credit Card: o Visa o Mastercard Card # _________________________ Expiry Date ____/_____ Cardholder Name _____________________________________ The parents/guardians submitting this application give their permission for any photographs, videos or testimonials of the applicant to be used in Lakeshore Arts promotional materials and on the Lakeshore Arts website and Facebook pages, unless indicated here (x): __ While all reasonable precautions are taken for the safety and good health of the campers, Lakeshore Arts staff are hereby released from any and all liability in the event of illness, accident or misfortune that may occur to the participant and his or her property. I have read, understood and agree with the conditions of enrollment. I, the undersigned, the parent/guardian of the aforementioned child, do hereby consent to his/her participation in ARTiculate Leadership in the Arts Program. Name: ___________________________________ Signature: ___________________________________ Date: ___________________ PARTICIPANT INFORMATION & CONDITIONS OF ENROLLMENT To be completed by youth applicant. ARTiculate Leadership in the Arts is a unique program that lets you work with professionals, improve your skills as an artist and gain leadership experience that you can include on your resume. There are only 12 spots in this program, and we are looking for participants who are willing to work collaboratively and who are creative, motivated, and open-­‐minded. Please respond to the following questions: (attach a separate page if necessary) Why do you want to participate in ARTiculate? How is art a part of your life? We often work collaboratively at ARTiculate. What do you bring to the team? How do think you will benefit from leadership experience? If you had one goal for yourself for this program, what would it be? The program runs from 10 am to 4pm daily. Can you attend each session? Yes____ No_____ If no, please note what days: Participant Pledge I, __________________________________________________ (name) will be respectful, kind and supportive of my fellow participants. I will not tease or criticize them. I will be respectful of the program leaders and artist facilitators. I will listen. I will be open-­‐minded and put forth my best effort in all aspects of the program. I will not use inappropriate language. I will demonstrate my commitment to the program by not being late or absent unless I am sick. I agree not to use my cell phone during program hours. I agree that the Camp Coordinator has the right to dismiss me from the program if I threaten the safety of other participants or disrupt their experience by rejecting the participant pledge. I have read, understood and agree with the above. Applicant Signature: ____________________________ Date: ___________________ Parent/Guardian Signature: ____________________________ Date: _____________ Please send completed applications to: Lakeshore Arts, 2422 Lake Shore Blvd. West Toronto ON, M8V 1C4 Attn: ARTiculate. Upon receipt of your application, we will contact you to arrange an interview with camp staff. Interviews will take place in mid-­‐ June.