Youth Outreach Program Application

Name

Preferred 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 choose your preferred day to attend the program:

***Please attach 3 examples of your artwork, in any medium:

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