Cape Cod Museum of Art | Creative Outlets

Creative Outlets:
finding your voice through arts

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 July & August.

Part One to be completed by teen applicant

Date

First Name

Teen's Last Name

Age

Date of Birth

School

Grade

Cell #

How did you hear about Creative Outlets?

What are your favorite activities?

Do you have any background in music, art, drama, dance or writing? Any crafts or other hobbies? Tell us.

What would you like Creative Outlets to know about you?

Please list any food allergies

Environmental allergies or sensitivities

List any medications you take

Other Health Issues

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.

Session One: July 11 - August 1

Session Two: August 8 - August 29

Part Two to be completed by Parent or Guardian

First Name

Last Name

Address

Cell Phone

Home Phone

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

Name

Relationship

Cell Phone

Home Phone

Name

Relationship

Cell Phone

Home Phone

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.

YES

Names

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

Teen's Signature

Parent/Guardian Signature

CCMoA Representative Signature

Date

Has your teen been vaccinated for COVID?

YES

I understand that my teen may be required to follow safety precautions including wearing a mask and keeping social distance.

YES

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.

Creative Outlets: finding your voice through arts

Part One to be completed by teen applicant

Creative Outlets:
finding your voice through arts