Event Registration

Mindful Bullet Journaling & Illustration Techniques for Teens (SEP 14 2024, 10:30 AM - 12:30 PM)

**Please wait until you receive confirmation about the status of your registration. Filling out this form does not guarantee a spot.**

Mindful Bullet Journaling & Illustration Techniques for Teens (September 14, 2024)

PARTICIPANT INFORMATION

Full Name(Required)

Nickname

Gender Pronouns

School(Required)

Grade(Required)

EMERGENCY CONTACTS

Parent/Guardian Name (main point of contact)(Required)

Parent/Guardian Relation to Participant(Required)

Phone # where Parent/Guardian can be reached during the program:(Required)

Parent/Guardian Email(Required)

Additional Emergency Contact Name(Required)

Emergency Contact Relation to Participant(Required)

Phone # where Emergency Contact can be reached during the program(Required)

Emergency Contact Email(Required)

ADDITIONAL INFORMATION + CONSENT

Is there anything that might be helpful for us to know about your child (medical, behavioral, other needs, etc.)?

Media Release(Required)

Yes

I hereby give permission to the Addison Gallery of American Art to use my child's name and photographic likeness in editorial and/or promotional material produced and/or published by the Addison in any form of printed or digital media. I waive any right to inspect or approve the finished product in which my or my child appears, or any copy that may be used in connection with it, now or in the future. I waive any right to royalties or other compensation arising from, or related to, the use of any photographic likeness.

Mindful Bullet Journaling & Illustration Techniques for Teens (SEP 14 2024, 10:30 AM - 12:30 PM)

PARTICIPANT INFORMATION

EMERGENCY CONTACTS

ADDITIONAL INFORMATION + CONSENT

Bartlett H. Hayes Prize Recipients

2023:

Reggie Burrows Hodges

2025:

Tommy Kha