Ag47 Youth Artist Application
Hello there! We are so excited that you're interested in joining our collective. This application is for the 2017-2018 year.

The first workshop is January 7th, 2018. The first group event will be in mid-December.

Ag47 Collective strives to do our best to make sure that all young people that apply are able to join our collective. This application is not about acceptance, but allows us to know a little more about you and to confirm with your guardian that you'll be able to attend.

If you have any questions, please send an email our way: ag47collective@gmail.com

This application is due by December 1st, 2017.

Youth Artist Information
Please answer all the questions below thoroughly for record keeping purposes
What is your full name?
Your answer
What do you prefer to be called?
Your answer
What are your pronouns?
Your answer
What is your phone number?
Your answer
What is your e-mail address?
Your answer
What is your mailing address?
Your answer
What school do you go to?
Your answer
What grade are you in?
Your answer
What is your parent/gaurdians name
Your answer
Parent/Guardians contact number
Your answer
Parent/Gaurdians email
Your answer
Parent/Gaurdians mailing address (if different from youth)
Your answer
What is your parent/guardians preferred method of communication?
What is the best time to call/email?
Required
Please provide three emergency contacts authorized to respond to situations in the case your parent/caregiver/guardian is not available (list name, relationship, and phone number)
Your answer
What is the mode of transportation you will use to get to/from program?
Required
I authorize my child to be released from the program only to the following adults or young adults over the age of 12 (in addition to emergency contacts) - Please list the first and last name of the person(s)
Who else is authorized to drive you to/pick you up from Ag47 workshops? (please provide full name, relationship, and phone number)
Your answer
If you have a concern about an unauthorized individual coming to pick up your child, please write the name of that person(s) below and speak to the Program Manager as soon as possible.
Your answer
I understand that youth will not be released to an adult not on this form and that any changes need to be made in person, over the phone, or in writing (signature and date)
Your answer
Artistic Information
Tell Us How You Express Yourself!
How do you express your creativity?
Your answer
What kinds of artistic activities do you enjoy?
Your answer
What is something unique about yourself that you bring to a group?
Your answer
What is something you have done or created that you are most proud of?
Your answer
What are you looking for from a mentor relationship/your future mentor? (Ex: learning how to be a professional artist, a friend of a different age/at a different point in life, etc).
Your answer
If you were an emoji, which one would you be?
Your answer
Ag47 Program and Workshop Expectations
If I become an Ag47 youth artist, I agree to communicate and check in with my mentor once a week.
Required
If I become an Ag47 youth artist, I agree to be open to new experiences, to trust the creative process, and to collaborate with and support the other members and artists.
Required
If I become an Ag47 youth artist, I will commit to attending every workshop. If there is a day I absolutely cannot attend, I agree to communicate with my mentor about it.
Required
Media Release
As the parent/legal guardian of the youth listed on this form, I give permission to Ag47 to record audio, images, videos or the likeness of my youth during Ag47 programming and events throughout the year. I also give specific permission for Ag47 , at its sole discretion, to use these audio, images, videos or likeness in Ag47 publications, marketing and marketing and promotional material, on Ag47's website and social media sites
Medical Information
Is your youth taking any medication, prescription or OTC? If yes, please list.
Your answer
Does your youth know how to self-administer and monitor medication? Ag47 does not administer or monitor medication for participants
Note: Most medication will NOT be dispensed or administered by Ag47 staff members. If your youth is prescribed medications: 1. Parents are responsible for sending the medication with their youth to programming 2. Parents must inform the leadership that their child is taking prescription OR over the counter drugs. 3. Parents should instruct their youth on the dosage and proper time to take medication. 4. In the case of Epipens and Asthma Inhalers, youth MUST keep their medications on them at all time during program. (sign below)
Your answer
Note: In case of a medical emergency, Ag47 reserves the right to call 911/seem ambulance transportation in the event we cannot reach a parent/caregiver/gaurdian. Any medical costs incurred will be at the expense of the parents/caregiver/gaurdian.
Ag47 provides youth with a snack during each workshop. Does your youth have any allergies or dietary restrictions we should be aware of? If yes, please list:
Your answer
Thank you for your interest! We will contact you with more information about our program soon. If you have any questions, or anything else you'd like us to know, type it here!
Your answer
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