Art of Love
This form is to be completed for the persons who will be attending our Art of Love classes. The information collected on this form is to help A.I.R. Project further understand the community we serve and those who will be learning and creating with us. In some cases, when available, participants may have the opportunity to receive something by mail which will require a mailing address. Additionally, please note that participation in our program may include video or photo images taken during the activity. By completing this form, you are agreeing to potential recording or photography taken during Art of Love Program.  (Please note: This form will be required for each participant). Art of Love is for youth ages 8 and older.
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Email *
Art of Love Flyer
What is your name (please list first and last name of  participant)? *
How old are you (the participant)? *
Are you male or female? (Please select the gender for the participant) *
If you are in school what grade are you (the participant) in? If you are not in school select N/A *
Have you (the participant) experienced or witnessed abuse, violence or bullying? *
Do you (the participant) struggle with self-esteem, self-love, self confidence? *
Would you (the participant) be interested in having a mentor or penpal? *
Do you (the participant) like to journal? *
What kind of expressive arts do you (the participant) like? *
Do you (the participant) have any food allergies? *
If you (the participant) have food allergies, please list below. Otherwise enter N/A. *
What is your mailing address? *
What is your (the participant) contact number? What is your parent/guardian contact number? (Please list both below) *
First and Last Name of parent/guardian (if a minor), otherwise enter N/A. *
Have you participated in other projects, activities, or programs offered by A.I.R. Project? *
What school do you (your child) attend? (Answer this question if you are in the Houston and surrounding areas and attend primary/secondary school in Houston or surrounding area. Otherwise enter N/A.) *
Household Income? *
What race/ethnicity do your household best identify with? Check all that applies. *
Required
Please identify an emergency contact in case parent/guardian is not accessible if an emergency occurs. Include name, number, and relationship to participant. *
Please list the name of an authorized person to pick up your child. For safety, a code word will be required to be provided for days an authorized person will be picking up your child. An ID would be required to verify authorized person. *
For the safety of your child, please confirm how your child will be picked up from the program classes? *
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