Participant Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Workshop

What workshop would you like to join?

Photography w/ Carmen (NYC)

Abstract Painting w/ Koi (NYC)

Vogue Dance w/ Angel (NYC)

Portrait Drawing w/ Jesse (NYC)

Skill Level *

I'm super new to art

I've got a basic understanding of art

I've got some art experience

I'm basically a pro

Participant's Ethnic Identity (choose all that may apply)

This data is used to help our organization apply to grants.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Pacific Islander or Native Hawaiian

White/Caucasian

Prefer not to answer

Other

Is your parent/guardian aware of your gender/sexuality orientation? *

This information will inform how we will reach out to you with further information.

Yes

No

The parent/guardian is filling this out

Phone

(###)

###

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