ADULT OPEN STUDIO

WHAT
Open Studio provides an inclusive opportunity for adults ages16 and up
to explore their own creativity in an open, supportive environment. For 2
hours, participants will have access to ACTs art supplies and will have the
opportunity create their own masterpieces! Along with this, there will
also be planned crafts for those who prefer a bit more guidance. Come
and enjoy a night of art and creativity at ACT!

WHERE The ACT Offices: 1140 Monroe NW, Suite 4101; GR, 49503
WHEN

SEND REGISTRATION
& PAYMENT TO:

Friday, February 13, 2015 from 6:30-8:30 pm

WHO
Anyone age 16 and up who is interested in creating art! Participants may
come one their own (there will be volunteer & staff supervision), with
friends or family, or with an aid (aids, whether a family member or staff
person are free). Limit 20 people.

COST

Artists Creating Together

1140 Monroe NW,
Suite 4101
Grand Rapids, MI 49503
Phone: 616-885-5866
Email: coordinator@
artistscreatingtogether.org

$5.00 per person

REGISTRATION
________________________________________________________________________________________________
Participants Name

Age

Disability

________________________________________________________________________________________________
Parent/Guardian Name*

________________________________________________________________________________________________
Primary Phone Number

E-mail

________________________________________________________________________________________________
Address
City, State, Zip
*Please indicate if you would like someone other than the Parent/Guardian to be the Emergency contact during Open Studio time
Method of Payment: ___ Check (Please make checks out to ACT)

___ Cash

_____

_____ American Express

Mastercard

____ VISA

_____ Discover

Payment enclosed? ___ Y ___N

________________________________________ _______________________________________________
Name as it appears on card

__________________
Billing Zip Code

Card Number

____________
Exp. Date

___________
CVV Code

Photo/Video Release Artists Creating Together (ACT) has my permission to publish my likeness and/or my artwork in any of their own
print, video, internet publication or social media application. It may also be used in media from a partner or community collaborator that
promotes the work of ACT, with ACT permission. I understand that I may or may not be identified specifically by name. This authorization will
remain in my file and will serve as ongoing authorization for the agency to obtain photos/videos at any time during my affiliation with ACT.

________________________________________________________________________________________________
Signature