Registration Form: Part 2

Payment Information
You may sign-up for individual classes or can buy them in packages for extra savings. **Scholarships are available on an as-needed basis. Questions? Contact Katie at program@artistscreatingtogether.org or #885-5866.

ACT Summer 2013 Art Camps!

This summer, ACT will offer a number of summer camps for kids of all ages! These programs offer opportunities for kids of all abilities to learn and grow togethermeeting new friends, building self confidence, and experiencing and enjoying the arts.

Youth Art Classes: Summer 2013

DESCRIPTION CLASS COST MY BILL
Classes for 5-8 year olds Class #1 ________________________ 1 Class: $60 Class #2 ________________________ 2 Classes: $110 Class #3 ________________________ 3 Classes: $160 Classes for 9-12 year olds Class #1 ________________________ 1 Class: $60 Class #2 ________________________ 2 Classes: $110 Class #3 ________________________ 3 Classes: $160 Classes for 13-16 year olds Class #1 ________________________ 1 Class: $60 Class #2 ________________________ 2 Classes: $110 Class #3 ________________________ 3 Classes: $160

$_______

$_______

Sign-up Today!

Basic Class Information

Classes meet at ACT (1140 Monroe NW, GR) unless otherwise noted Class size is generally 10-15 students Classes are taught by professional teaching artists Need-based scholarships are available (see registration form for more information)

$_______ $_______

MY TOTAL COST

Artists Creating Together is a nonprofit organization that brings the arts and art project to children, youth and adults with disabilities from West and Northern Michigan.

PAYMENT INFORMATION Method of Payment: ___ Credit Card ___ Mastercard ___ VISA Billing Zip Code _________ Exp.______ Account # _______________________________________________ ___ Check (Please makes checks payable to ACT) ___ Cash Payment is enclosed ____ Yes ____ No Send form and payment to ACT: 1140 Monroe NW, Suite 4101; Grand Rapids, MI 49503

Special Program Opportunities

Special Programs

(continued on pg 2)

EVENT
Frederik Meijer Gardens Family Fun Night

DAY
TBD

TIME
6:00-7:30pm

COST
Free!

Family Fun Night at the Gardens! Meijer Gardens will be hosting a family fun night for ACT participants and their families in the Childrens Garden. Interested in coming? Email Katie at program@artistscreating together.org with your name and address to get your name on the mailing list to be the first to know when the date is solidified.

Youth Art Classes Summer 2013

CLASS WEEK
June 10-13 July 8-11 August 5-8

Registration Form: Part 1

COST

TIME
10:00am12:00noon 10:00am12:00noon 10:00am12:00noon

5-8 years

Dance & Movement Camp Art Around the World! Percussion Camp

$60.00 for 1 class; $110 for 2; $160 for 3 $60.00 for 1 class; $110 for 2; $160 for 3 $60.00 for 1 class; $110 for 2; $160 for 3

Classes are capped at 15 people, so sign up today! Unfortunately, if fewer than 5 people sign up for a class, it will be cancelled.

Registration
Participants Name__________________________________________ Date of Birth_______________ Age ______ Guardian's Name___________________________________________ Address ___________________________________________________ City___________________________________ Zip ________________ Phone ___________ Email___________________________________ Emergency Contact Person ___________________________________ Emergency Contact Phone_____________________ Disability (please check all that apply) ____ LD ____ ASD ____ CI ____ EI ____TBI ____ CP ____ DS ____ BLIND/VI ____ DEAF/HI ____ WHEELCHAIR ____ MULTI ____ OTHER (please list) __________________________ ____ ALLERGIES (PLEASE LIST) ________________________________

CM & Dance: Express yourself through dance using fun props and dancing to story-songs. Art Around the World: Explore the world through Art! Create beautiful artwork based on the art of countries throughout the world. Drumming: Have fun playing drums with friends, while practicing listening skills and working on rhythm.

CLASS

WEEK
June 10-13 July 8-11

TIME
12:30pm2:30pm 12:30pm2:30pm

COST
$60.00 for 1 class; $110 for 2; $160 for 3 $60.00 for 1 class; $110 for 2; $160 for 3

9-12 years

Dance & Movement Camp Art Around the World!

Drum August 5-8 12:30pm$60.00 for 1 class; $110 Camp 2:30pm for 2; $160 for 3 Dance & Movement: Learn new dances, create a dance of your own, use unique props, and make new friends! Art Around the World: Explore visual art from around the world by creating different art projects using a variety of unique materials! Drumming: Play and learn about different kinds of drums, create music with a group, and record a song of your own!

13-16 years

CLASS
Dance & Movement Camp Art Around the World! Drum Camp

DAY
June 10-13 July 8-11 August 5-8

TIME

COST

3:00-5:00pm $60.00 for 1 class; $110 for 2; $160 for 3 3:00-5:00pm $60.00 for 1 class; $110 for 2; $160 for 3 3:00-5:00pm $60.00 for 1 class; $110 for 2; $160 for 3

Assistant ACT encourages participants to bring an assistant if necessary for meaningful participation in class. There is no cost for assistants. Please note that we will not provide art supplies for assistants as the purpose of the assistant is to help the participant, not to work on his or her own art project. Name of Assistant __________________________________________ Photo Release: 2013
I grant Artists Creating Together permission to photograph me(if you are your own guardian)/ my student and the right to use, publish, reproduce and disseminate any photograph of me/my child or their artwork obtained in connection with the classes taken at ACT without payment compensation to me/my child. Signature _________________________________________________

Dance & Movement: Learn new dances, express yourself by creating dances of your own, use unique props, and make new friends! Art Around the World: Explore visual art from around the world by creating different art projects using a variety of unique materials! Drumming: Play and learn about different kinds of drums, create music with a group, and record a song of your own!