HOLIDAYGATHERING — YOUTH ARTS ALLIANCE

Youth Arts Alliance Holiday Event Registration

Youth Arts Alliance Participant Registration Form
Join us for an evening of food, connection, and creation as we come together to share space and create stunning glass pieces for yourself or someone special! Everyone will have the opportunity to explore and play (safely!) with glass, resin, and fire. In this focus-intensive practice, we will be nipping and cutting glass, mixing and pouring resin, and firing our pieces with a butane torch. *Please note: pieces will have to stay in the work area for at least 24 hours in order for the resin to cure. Arrangements will be made for pick up or shipping.

The event is free and open to members of MAGIC, REACH, MYOI and Blavin Scholars. It will be at Chapelle Business Center, located at 111 S Wallace, Ypsilanti, MI 48197.

The closest bus stops are on route 6: Congress & Wallace from the Blake Transit Center; Michigan Ave & Wallace from the Ypsilanti Transit Center.

Dinner and refreshments are provided. All supplies & materials are provided.

Date: Friday, December 1

Time: 5:30 - 8:00pm

Location: Chapelle Business Center, located at 111 S Wallace Blvd, Ypsilanti, MI 48197

Space is limited and you will be notified when your space is reserved.

Questions? Please reach out to Chinelo Onuigbo, YAA Program Manager, at chinelo@youthartsalliance.org

YAA Workshop Registration
Participant Name*

First NameLast Name
Participant Preferred Name
Participant Age*
Participant Email*
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Participant Phone Number*
Please enter a valid phone number.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Relationship to Participant*
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Allergies or dietary restrictions?*
Which program are you currently part of?*

MAGICREACHMYOIBlavin Scholars
Any additional information or support that we need to know about to provide the best experience?

Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Relationship to Participant*
Emergency Contact Phone Number*
Please enter a valid phone number.

Release & Consent
As part of their participation in Youth Arts Alliance programming I understand, acknowledge, and fully appreciate any risk of injury that may result from my and/or my child's participation in the program.

It is my understanding that I and/or my child will be subject to the policies, rules, and regulations of Youth Arts Alliance while participating in the program.

I fully recognize, understand, and assume any risks to which I and/or my child may be exposed by participating in the program. I understand that I and/or my child is not required to participate in the program. I acknowledge that there may be dangers and risks not known to us or not reasonably foreseeable at this time. I release, waive, and forever discharge Youth Arts Alliance from and against any and all liability for any harm, injury, death, damage, claims, demands, actions, cause of action, costs and expenses of any nature that I and/or my child has or that may hereafter accrue to me/us/my child, arising out of or related to any loss, damage, injury, including but not limited to death that may be sustained by me and/or my child, whether caused by negligence or carelessness of the Releasees or otherwise, while participating in the program.

I hereby delegate to Youth Arts Alliance, its employees and contractors, the authority to seek, obtain, and approve any emergency medical care and treatment which is deemed advisable by and is to be rendered under the general supervision of any physician or surgeon, for me and/or the below named minor during his/her/their participation in the program. I understand that I am responsible for any costs incurred that are not covered by my insurance and I agree to defend, indemnify and hold harmless Youth Arts Alliance against any and all liability arising out of any action they may take in seeking, obtaining or approving emergency medical treatment for me and/or the below named minor.
Media Release

I understand that during the course of my and/or my child's participation in Youth Arts Alliance (YAA) activites, that YAA, and those acting with YAA’s permission or authority, may capture my and/or my child's name, likeness, image, or voice in photographic, audio, video, digital or other recording forms (“Recordings”). I give my permission for YAA to use those Recordings or works produced (e.g., art work, poetry, music) for promotional, informational, and educational purposes in any and all media now existing or hereafter devised, for any purpose consistent with the YAA’s mission. I understand that I will not have an opportunity to review or approve uses of the Recordings or Creative Works.

I recognize that the Youth Arts Alliance holds the copyright in all Recordings. I understand that I will not receive payment or any other compensation for the taking or use of any Recordings or Creative Works created as a result of participation in the Program.

I release, indemnify and hold harmless the Youth Arts Alliance from and against all liability, actions, debts, claims and demands of every kind whatsoever to the taking or use of my and/or my child's Recordings or Works.
Participant Full Name*

First NameLast Name
Participant Signature*

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Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*
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Youth Arts Alliance Participant Registration Form

YAA Workshop Registration

Emergency Contact Information

Release & Consent

YOUTH ARTS ALLIANCE | 209 Pearl St, Ypsilanti, MI 48197

admin@youthartsalliance.org