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Please complete the application below and click the SUBMIT button.

Upon review, teen and parent or guardian will be scheduled for an interview

Applicants will be notified of their enrollment status shortly after the interview.

Interviews will be held in May, June & July.

Part One to be completed by teen applicant
I am interested in attending Session One and/or Session Two. I understand that signing up for a session means I will attend all 4 workshops in that session.

Part Two to be completed by Parent or Guardian

Please list an emergency contact in case Parent or guardian is not able to be reached.

I grant permission for CCMoA to discuss and share information regarding my child with relevent therapists. If yes, please provide the names of school guidance counselors, medical professionals, or teachers where appropriate.

I understand that I may withdraw the above authorization at any time by giving written notice to CCMoA.

Has your teen been vaccinated for COVID?
I understand that my teen may be required to follow safety precautions including wearing a mask and keeping social distance.

Thanks for submitting!

Please list the adults, other than guardians, with whom your teen is allowed to

leave the program.

From time to time, CCMoA will share information and seek out support from other caring professionals who are participating with this program to better serve the teens. Granting permission to discuss behavioral approaches and issues with school mental/health providers is optional, not mandatory, to participate in the Creative Outlets program.