Teen Art Program Application Winter/Spring 2018
Please complete the following form to register yourself or your teen for our Teen Art Program. A parent or guardian will need to complete the waiver portion of the form.
Student Information
Name (First, Last) *
Your answer
Student Gender Identification *
Date of Birth *
MM
/
DD
/
YYYY
Info on registering for classes:
Register for classes by clicking below on the classes that you would like to attend. You are not required to attend all of the classes. It is preferred that you be able to take at least 3 days of a category (Comic/Fine Art/Print/Sculpture) and preference will be given to students that register for multiple courses. All materials are provided by Push/Pull. Students need to arrive with any tools or materials that they have been given for a course.
Classes Registering: *
Required
Student Phone *
Your answer
Student email *
Your answer
Optional Questions
Questions below are optional details about the student, but allow us to collect data for grant eligibility. Please let us know if you have questions or concerns. Identifying information about your student will never be released without the student and guardian permission.
Student's Race
Does student identify as LGBTQ+?
Is the student or student's parents an immigrant?
Student family household annual income
Number of Family Members at primary home
Your answer
Does the student have a job?
Information about your student that we should know (optional, do not include health information here)
Your answer
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