Self Help Graphics & Art 2019 S.O.Y. Artista Registration & Release Form
*** Group A 12-17 is at capacity. Any additional sign-ups will be added to a wait list.

PROGRAM DATES:
July 9- August 10, 2019
Tuesday- Friday, 10 am- 3 pm

Self Help Graphics & Art
1300 E. 1st Street
Los Angeles, CA 90033

By submitting this form, you are committing to participating in S.O.Y. Artista for full 1-week (Tuesday-Friday) blocks of time. Each medium covered in the program is taught over the course of one week, so you must be able to attend the full week that you have signed up for.

We will follow up as July gets closer, to confirm the student's participation in the program.


MEDICAL AND STANDARD APPEARANCE RELEASE FORM FOR YOUTH PROGRAMS
* This form must be signed by a parent or guardian if student is under 18 years of age.

MEDICAL RELEASE
The undersigned does hereby authorize the officers, teachers, or agents of Self Help Graphics & Art (SHG) and the public school or community center officers/staff to consent to any X-ray examination, anesthetic, or medical procedure necessary in a medical emergency. It is understood that this authorization is given in advance to provide authority and power to render care, which the attending physician in his or her best judgement may seem advisable. It is understood that every effort shall be made to contact the undersigned prior to rendering treatment. List any medical conditions, allergies, medications, and other heath related issues you want SHG to be aware of.

STANDARD APPEARANCE RELEASE
I understand that Self Help Graphics & Art (SHG), is a non-profit organization and nationally recognized center for Latino arts that develops and nurtures artists in printmaking. SHG seeks to advance Latino art broadly through programming, exhibitions, and outreach to diverse audiences in East Los Angeles and beyond. SHG seeks to identify and engage young and emerging artists from the community in all aspects of its activities. To describe and promote its efforts, conducts a free summer youth art workshop, titled S.O.Y. (Summer of Youth) Artista. I authorize SHG in collaboration with participants, to record and edit my name, image, voice, artwork, interview, and/or performance for the above named project and related materials. All videotape, audiotape, printed materials, and photographs are property of SHG, however copies will be provided to the students whenever possible. I hereby grant the irrevocable right and permission to SHG and related parties to use a photograph of me, my artwork, a photograph of my artwork, or a photograph taken by me for publication in the news media or electronically via the internet or in other displays for education, non-profit, visual art publications, and exhibitions.

Email address *
Participants Name: *
Your answer
Participants Phone Number: *
Your answer
Participant Date of Birth *
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Is the SOY Artista participant under 18? *
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