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.

Graduated Art Classes: Summer 2012

DESCRIPTION
Sign up for two Grad Art classes Sign up for three Grad Art classes

ACT Youth and Adult Summer Classes

SAVINGS
This summer, ACT (formerly VSA) will offer a number of classes and opportunities for both youth and adults! These programs offer opportunities for building a community, meeting new friends, and building self confidence, all while learning and enjoying art.

COST

$135 $190
CLASS COST
1 Class: $75 2 Classes: $135 3 Classes: $190 Movie Night: $5

10% 15%
MY BILL

DESCRIPTION
Class #1 ________________________ Class #2 ________________________ Class #3 ________________________ Circle: Movie Night Volunteering

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) Graduated Art classes are for students 16 and older and youth classes are broken into three different age groups (see class schedule)

Youth Art Classes: Summer 2012

DESCRIPTION
Sign up for two 5-week classes (all classes for 4-7 years & 7-12 years are 5 week classes)

Sign-up Today!
SAVINGS

COST

$75.00
CLASS COST

10%
MY BILL

DESCRIPTION

Classes for 4-7 year olds Class #1 ________________________ 1 Class: $40 Class #2 ________________________ 2 Classes: $75 Classes for 8-12 year olds Class #1 ________________________ 1 Class: $40 Class #2 ________________________ 2 Classes: $75 Classes for 12-16 year olds Class #1 ________________________ 1 Classes: $75

Graduated Art Classes & Programs

$_______
Special Programs
Graduated Art classes are for students 16 years and older.

(continued on pg 2)

EVENT
Volunteering at Meijer Gardens

DAY
Monday, May 21

TIME
4:30-7:30pm

COST
No Cost

$_______ $_______ $_______

Volunteer: ACT is providing arts and crafts for an early childhood special education event at Meijer Gardens and we would love your help!

EVENT
Movie Night

DAY
Friday, June 8

TIME
6:30 9:00 pm

COST
$5

MY TOTAL COST

Movie Night: Enjoy a movie night with your friends at ACT. Night includes movie, popcorn and pop.

Graduated Art Classes: Summer 2012

Adult Classes CLASS
Pottery Drumming Creative Movement & Dance

Registration Form: Part 1

COST
$75.00 $75.00 $75.00

DAY
Mondays: 6/11-8/13 Tuesdays: 6/12-8/14 Thursdays: 6/14-8/16

TIME
6:30-7:30pm 5:00-6:00pm 11:30-12:30noon

Classes are capped at 15, so sign up today! And unfortunately,

if fewer than 5 people sign up for a class, it will be cancelled. Registration

NEW!

Pottery: Students will learn to sculpt, mold, and manipulate clay to create beautiful pieces they will take home with them. Drumming: Students will enjoy playing and learning about different kinds of drums and will end by creating a song of their own. CM & Dance: Dance and CM will take place in a fun, community environment with students learning new moves and creating new dances.

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) ________________________________ * Ask about scholarships for individuals with Autism Spectrum Disorder
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: 2012

Youth Art Classes: Summer 2012

CLASS 4-7 years
Drumming Creative Movement/Dance

DAY
Tuesdays: 6/12-7/10 Thursdays: 7/19-8/16

TIME
3:30-4:30pm 10:00-11:00am

COST
$40.00 or 2 for $75.00 $40.00 or 2 for $75.00

Drumming: Students will have fun playing drums with friends, while also practicing listening skills and working on rhythm. CM & Dance: This class will focus on expressing oneself through dance using fun props and dancing to story-songs.

CLASS 8-12 years

Creative Movement/Dance Drumming

DAY
Thursdays: 6/14-7/12 Tuesdays: 7/17-8/14

TIME
10:00-11:00am 3:30-4:30pm

COST
$40.00 or 2 for $75.00 $40.00 or 2 for $75.00

CM & Dance: In this class, students will learn new dances, create a dance of their own, and all in a fun, unintimidating environment. Drumming: Students will enjoy playing and learning different kinds of drums and will end by creating and recording a song of their own.

12-16 years

CLASS
Pottery

DAY
Mondays 6/11-8/13

TIME
5:00-6:00pm

COST
$75.00

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 _________________________________________________
Payment Information: See back for payment information. Make checks payable to ACT. Send form and check to ACT: 1140 Monroe NW, Suite 4101; Grand Rapids, MI 49503 Questions? Call or email Katie: #885-5866, program@artistscreatingtogether.org

Pottery: Students will learn to sculpt, mold, and manipulate clay to create beautiful pieces they will take home with them.