Art Against Bullying Application Form
This application is for middle school students who would like to participate in the #ARTAGAINSTBULLYING workshop and exhibition at Palenke Arts in Seaside. The workshop takes place Sundays from noon - 3 pm for four weeks, beginning April 8, 2018. There will be a pop up exhibition of art created in the workshop on Sunday, May 6 from 1 - 3:00 pm. There is no cost to participate in this program. We do have limited space. Please only apply if you are available on all of those dates (including the exhibition), and have transportation to/from Palenke Arts.
This information will not be shared with anyone other than the administrators of the You Will Rise Project and Palenke Arts.
Name *
Your answer
Age *
Your answer
Grade *
Applicant must be in middle school
Address *
Street, City, State, and Zip Code
Your answer
Phone number *
with area code
Your answer
E-mail address *
Your answer
Parent/Guardian name *
Your answer
Parent/Guardian e-mail address *
Your answer
Parent/Guardian phone number *
with area code
Your answer
Emergency contact *
Name and phone number
Your answer
School *
Your answer
The following questions will help us learn more about why you are interested in participating in the Art Against Bullying workshop and exhibit. Please keep responses to 2-3 sentences each.
Have you been bullied? *
If yes, please describe your experience(s). *
Has a bully physically hurt you? Did you remain silent? Did you tell an adult?
Your answer
Do you enjoy being creative? If so, what are your favorite creative outlets? *
Your answer
Do you want to meet others who also understand the pain of being bullied? *
I am available on the dates of this project and have transportation to OGS. *
I grant to You Will Rise Project the right to take photographs of me and my artwork in connection with the above-identified event. I authorize You Will Rise Project to use and publish the same in print and/or electronically.

I agree that You Will Rise Project may use such photographs and video of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. I have read and understand the above.

Note: If you do not consent, you will not be omitted from this opportunity. *
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