Payment Information

You may sign-up for individual classes or can buy them in packages for ex-
tra savings. **Scholarships are available on an as-needed basis. Questons?
Contact Kate at program@artstscreatngtogether.org or #885-5866.
Registration Form: Part 2
Youth Art Classes: Summer 2014
DESCRIPTION CLASS COST MY BILL
Classes for 5-8 year olds
Class #1 ________________________
Class #2 ________________________
Class #3 ________________________


1 Class: $60
2 Classes: $110
3 Classes: $160








$_______

Classes for 9-12 year olds
Class #1 ________________________
Class #2 ________________________
Class #3 ________________________


1 Class: $60
2 Classes: $110
3 Classes: $160








$_______

Classes for 13-16 year olds
Class #1 ________________________
Class #2 ________________________
Class #3 ________________________


1 Class: $60
2 Classes: $110
3 Classes: $160








$_______
MY TOTAL COST

$_______
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
This summer, ACT will ofer a number
of summer camps for kids of all ages!
These programs ofer opportunites
for kids of all abilites to learn and
grow togethermeetng new friends,
building self confdence, while
experiencing and enjoying the arts.
ACT Summer 2014 Art Camps!
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 artsts
Need-based scholarships are
available (see registraton form for
more informaton)
Sign-up
Today!
Special Program Opportunities (continued on pg 2)
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EVENT DAY TIME COST
Open Studio Night
Thurs. 6/26 6:00-8:00pm $5/person
Frederick Meijer Gar-
dens Family Fun Night
Thurs. 7/17 6:00-7:30 pm Free!
Open Studio Night at ACT! Come for an evening of art-making, where you get to
choose your own art materials to work with and projects to create! Students 10 +
may come on their own (there will be volunteer & staf supervision) or may come
with an aid (free), friends or family. Students 6-10 must be accompanied by an adult.
Family Fun Night at the Gardens! Meijer Gardens is hostng a family fun night for
ACT partcipants and their families in the Childrens Garden. Interested in coming?
Email Kate at program@artstscreatngtogether.org for a form.
Artsts Creatng Together is a non-
proft organizaton that brings the
arts and art project to children,
youth and adults with disabilites
from West and Northern Michigan.
CLASS WEEK TIME
Dance & Movement Camp June 23-26 10:00am-12:00noon
Art Around the World! July 14-17 10:00am-12:00noon
Drum Camp August 4-7 10:00am-12:00noon
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CLASS DAY TIME
Dance & Movement Camp June 23-26 3:00-5:00pm
Art Around the World! July 14-17 3:00-5:00pm
Drum
Camp
August 4-7 3:00-5:00pm
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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
creatng diferent art projects using a variety of unique materials!
Drumming: Play and learn about diferent kinds of drums, create music
with a group, and record a song of your own!
Dance & Movement: Learn new dances, express yourself by creatng
dances of your own, use unique props, and make new friends!
Art Around the World: Explore visual art from around the world by
creatng diferent art projects using a variety of unique materials!
Drumming: Play and learn about diferent kinds of drums, create music
with a group, and record a song of your own!
Youth Art Classes Summer 2014
Registration
CM & Dance: Express yourself through dance using fun props and
dancing to story-songs.
Art Around the World: Explore the world through Art! Create beaut-
ful artwork based on the art of countries throughout the world.
Drumming: Have fun playing drums with friends, while practcing
listening skills and working on rhythm.
CLASS WEEK TIME
Dance & Movement Camp June 23-26 12:30pm-
2:30pm
Art Around the World! July 14-17 12:30pm-
2:30pm
Drum
Camp
August 4-7 12:30pm-
2:30pm
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Registration Form: Part 1

Partcipants Name____________________________________________
Date of Birth_______________ Age ______ Male/Female ___________
Guardian_____________________________________________________
Address _____________________________________________________
City_________________________ State ________ Zip ________________
Phone ___________ Email_______________________________________
Emergency Contact Person _______________________________________
Emergency Contact Phone________________________________________
Ethnicity
____ African American ____ Caucasian ____ Hispanic/Latno
____ Natve American ____ Other

Disability (please check all that apply)
____ ASD ____ BLIND/VI ____ CI ____ DEAF/HI ____ EI ____ OHI
____ PI ____ SXI ____ SLD ____ SLI ____ TBI ____ WHEELCHAIR
____ ALLERGIES (PLEASE LIST) ________________________________

Assistant
ACT encourages partcipants to bring an assistant if necessary for meaning-
ful partcipaton 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 partcipant, not to work on his or her own art project.
Name of Assistant __________________________________________

Photo Release: 2014
Artsts Creatng Together (ACT) has my permission to publish my likeness in any of their
own print, video, internet publicaton or social media applicaton. It may also be used
in media from a partner or community collaborator that promotes the work of ACT,
with ACT permission. I understand that I may or may not be identfed specifcally by
name. This authorizaton will remain in my fle and will serve as ongoing authorizaton
for the agency to obtain photos/videos at any tme during my afliaton with ACT.

Signature _________________________________________________

Classes are capped at 15 people, so sign up today! Unfortunately,
if fewer than 7 people sign up for a class, it will be cancelled.
Registration form due 2 weeks prior to first day of class.
Registration
Demographic Information (for granting purposes)