Youth Artist Program application form
Welcome to Taller Puertorriqueño's Youth Artist Program (YAP).  YAP is an after-school arts program dedicated to promoting the cultural, artistic, and academic enrichment of our youth in Philadelphia. We require the contents of this application to be complete. If there is information you are unable to collect, please let us know so we can assist you. At the end of this application, you must attach the following copies of documents for registration:

-Current student health evaluation (physical) from a physician.

-Most recent academic evaluation (Report Card).

-Copy of Health Partners medical card (Health Partner clients only).

If it is more convenient to send the documentation by mail, or email is also acceptable. Please send it as attention to:

Ashleen Castillo YAP Coordinator

Taller Puertorriqueño 2600 N. 5th street Philadelphia, PA 19133

acastillo@tallerpr.org

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Program Fee and Payment

YAP has an annual registration fee of $30.00. Payment is made in person via cash, check, or credit/debit card. The registration fee is waived if the student is a Health Partners member. A copy of the student's Health Partners card is required. If you need a copy of your card, please let us know and we can provide it here at Taller Puertorriqueño.

Student Name *
First and last name
Student's Date of Birth
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Student Email *
Student Phone number *
Residential address *
Name of high school or program student is attending:
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Student's current grade: *
Obligatorio

Parent or Guardian's name: 

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Relationship:

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Parent/Guardian's phone number:

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Parent/guardian's email address:
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Parent/Guardian Consent

Will you allow the Youth Artists Program and Taller Puertorriqueño staff to obtain emergency medical care in the event of an urgent emergency? This includes taking your child to the nearest hospital emergency department or calling an ambulance.

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Will you allow your child to attend field trips or participate in activities supervised by the Young Artists Program and Taller Puertorriqueño within a five-mile radius of our address at 2600 N. 5th street? These activities would be fairs in the park, outdoor art activities, and visits to the library or other schools in the surrounding area.

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Emergency Contact List

Provide a list of 3 authorized emergency contacts if you, parent or guardian are not available in the event of an emergency. Name, relationship and phone number.

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