Youth Outreach Program Application Name Pronoun: Date of Birth: Age: Phone (Cell) Phone (Home) Street Address: City: Province Postal Code: Email: School: Grade: First Emergency Contact Name: First Emergency Contact Phone Number: Second Emergency Contact Name: Second Emergency Contact Phone Number: Allergies: Where did you find out about the Youth Outreach Program? Why are you interested in taking the Youth Outreach Program? What would you like to learn and achieve from the program? Describe your experience with art making. ***Please attach 3 examples of your artwork, in any medium: Apply Now! What's On / What's Next HorizonLine/BaseLine // James Boychuk-Hunter May 10, 2022 Martha Street Studio Seeks Community Outreach Workshop Facilitators April 26, 2022 Terra Firma // Mark Laurin February 15, 2022 2022 Youth Outreach Program Showcase February 9, 2022