Ag47 Youth Artist Application
Hello there! We are so excited that you're interested in joining our collective. This application is for the 2019-2020 year.  Our season runs January through April, meeting on Sundays from 2-5pm in Logan Square.

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

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Ag47: Amplifying Creative Voices
http://ag47collective.org

Ag47 knows that young folks creative voices should be amplified and their stories shared. The collective achieves this through artistic collaboration and one-to-one mentorship between youth artists and adult mentors. Ag47 prioritizes and strives to lift up the voices of girls, femme identities, trans and gender nonconforming folx, and individuals seeking brave space through creativity and community. By encouraging each other to take risks, ask questions, and present work to a public audience, AG47 provides youth with the chance to be heard and their communities with the chance to listen.



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Youth Artist Information
Please answer all the questions below thoroughly for record keeping purposes
What is your full name? *
What do you prefer to be called?
What are your pronouns?
What is your phone number? *
What is your e-mail address? *
What is your mailing address? *
What school do you go to? *
What grade are you in? *
What is your parent/gaurdians name *
Parent/Guardians contact number *
Parent/Gaurdians email *
Parent/Gaurdians mailing address (if different from youth) *
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) *
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) *
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.
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) *
Artistic Information
Tell Us How You Express Yourself!
How do you express your creativity?
What kinds of artistic activities do you enjoy? *
What is something unique about yourself that you bring to a group?
What is something you have done or created that you are most proud of?
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).
If you were an emoji, which one would you be?
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. *
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) *
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: *
How did you hear about Ag47? *
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!
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