Creative Workshop Scholarships | Memorial Art Gallery

Scholarships are an invaluable way for students to access art education. Fill out the form below for MAG’s Creative Workshop scholarship opportunity.

Creative Workshop Scholarship Application Form

Participant Name

First Last

The participant is interested in a:

Class

Camp

Other

What class/camp is the participant interested in attending?

Why does the participant want to attend a class or camp at the Creative Workshop?

What is the scholarship amount that you are requesting?

What additional information about your financial status would be helpful in determining your scholarship need?

Participant Information

I am filling this form out for:(Required)

Myself

A child or teen

Registering Adult's Name

First Last

Registering Adult's Relationship to Participant

Home Address

Street Address Address Line 2 City State ZIP Code

Phone

Participant's Date of Birth

Other Adult Authorized for Pick-up #1

First Last

Phone Number for Authorized Adult #1

Other Adult Authorized for Pick-up #2

First Last

Phone Number for Authorized Adult #2

Emergency Contact Name

First Last

Emergency Contact Phone Number

Emergency Contact Email

Does your child have an allergy?

Yes

What is your child allergic to?

Will the child be taking any medication while at the workshop?

Is there anything else that we should know?

(Examples: ASL Interpreter Request, student will come with a supporting adult, etc.)

Creative Workshop Policies & Consent

U of R Rules of Conduct Agreement

By registering this child for class, I understand that per the University of Rochester’s Programs for Minors Policy, the following Rules of Participation apply to them and that their failure to comply with these rules will result in the immediate dismissal of the child from the program with no refunds given:

The possession or use of alcohol and other drugs, fireworks, guns and other weapons is prohibited.
Participants may not leave university property or the program without permission of the Program Sponsor.
No violence by anyone involved with the program, including sexual abuse or harassment, will be tolerated. Hazing is prohibited. Bullying, including verbal, physical, and cyber bullying, are prohibited.
No use of tobacco products.
Misuse, damage, or theft of property is prohibited. Charges will be assed against those participant who are responsible for damage, theft or misuse of university property.
Participants must follow all safety rules in accordance with university standards and/or as defined by the program administrator.
Use of cameras, imaging, and digital electronics is prohibited where privacy is expected, such as showers, lockers rooms and restrooms.

Statement of Risk and Liability, Certificate of Health Emergency Waiver

In consideration for allowing your child to participate in this Creative Workshop program I, as his/her parent/guardian represent and affirm to the University of Rochester that:

I understand that participating in any activity involves a risk of injury or harm.
All such risks are being assumed knowingly and voluntarily, including but not limited to those associated with travel to and from the Program.
I certify that my child is in good health and has no physical condition that would prevent him/her from participating in the Program.
In the event of the Program’s inability to locate me, or the emergency contact designee, I give permission to the Program Authorities to take such emergency measures, as they deem appropriate until such time as emergency contact designee or myself can be contacted.
I will not hold the University, its employees, and agents responsible for any injury or other harm that results from Program participation.

Refund Policy

All class registrations are non-refundable with the exception of those that have been canceled due to inadequate enrollment. The Workshop reserves the right to cancel any class, in which case a full refund is issued.

Please note: Behavior problems deemed sufficiently disruptive will result in a child’s removal from the program. No refunds are made in these cases.

Comments

This field is for validation purposes and should be left unchanged.