Summer Application 2022

DreamYard — Summer Application 2022

ART CENTER PROGRAMS

SUMMER APPLICATION 2022

HIGH SCHOOL PROGRAM OFFERINGS

We are at capacity. High School students may register for the Fall and sign up to receive general information.

MIDDLE SCHOOL PROGRAM OFFERINGS

THIS CLASS IS FOR MIDDLE SCHOOL STUDENTS ONLY. Summer programs for Middle School will run from July 18th- August 12th. BXLL (Bronx Liberation League) Monday-Thursday 10am-1pm (Time may change). Explore various art forms including painting, sculpting, dancing, film, photography, poetry and produce innovative original art pieces that make a social statement.

STUDENT INFO

Student Name *

First Name

Last Name

Date of Birth Address * Address 1 Address 2

City

State/Province

Zip/Postal Code Country Cell Phone * Email Address * Gender Gender Pronoun School Name School Grade Are you new to Art Center Programs? If yes, how did you hear about our program?

PARENT/GUARDIAN INFO

Parent/Guardian Signature * Typing your name acknowledges the terms above.

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Relationship to Parent Parent/Guardian Cell Phone Language Spoken at Home Does your child have any medical, emotional or physical needs that we should know of? (Allergies, physical limitations, etc.) Please provide extensive details:

EMERGENCY CONTACT

Emergency Contact Name * Emergency Contact Phone * Emergency Contact Relationship to Student Parent/Guardian Release *

LIABILITY

I hereby release DreamYard Project and any organization with which it might contract for service, from any and all liability for any injury that might befall my child during their participation in any program. I understand the details of the program my child is registering for and know that the program is not only educational and cultural, but can also have physical activity associated with it and the use of professional tools/equipment. I grant DreamYard Project permission to provide immediate medical care to my child whether by DreamYard staff or a medical professional at their discretion and to the best of their ability.

I acknowledge and agree that my son/daughter shall act in a responsible manner and follow all rules pertaining to these activities and understand that the violation of the rules may result in the participant being sent home at the parent/guardian’s expense.

PHOTO/VIDEO CONSENT

I also grant DreamYard Project the right to use photographs and/or video and other records of my child’s likeness, biography, voice and sounds during her/his participation with DreamYard Project for publicity purposes without compensation to me; this includes but does not limit: art work, programs, projects, or products my child has worked on/created. I further grant DreamYard Project to assist my child in any academic counseling, services, or educational advice.

By selecting this box I agree to the above release for participation in Art Center Programs