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Home
About
Our Team
Board of Directors
In the News
2023 Year in Review
Creative Clay 990
Programs
Community Arts Program
Transition
Artlink
Artlink Takamatsu-St. Petersburg
Creative Care
Creative Thrift
Artists
Support
Donate
Good Folk Society
Visionary Society
Become A Sponsor
Supporters
Impact
Partnerships
Volunteer
Events
Upcoming Events
Calendar
Gallery
Good Folk Gallery
SHOP
Equality through art since 1995
DONATE
Apply to be a Member Artist
Use the form below to be a Creative Clay Member Artist
Please complete the form below
Name
*
First Name
Last Name
Date of Birth
MM
DD
YYYY
Gender
*
Male
Female
Non Binary
Race/Ethnicity
Creative Clay is committed to promoting diversity in all of its programming. Some grant funders require this data collection. Please select all that are appropriate or choose not to respond.
Black/African American/African
Hispanic/Latino/Latina/Latinx
White/Caucasian/European
Asian American/Asian/Pacific Islanders
Native American/American Indian/Indigenous
Multi-Racial/Multi-Ethnic (2+ races/ethnicities)
I decline to state
Parent/Guardian Name
*
Phone Number
*
(###)
###
####
Email Address
*
Mailing Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Support Coordinator
First Name
Last Name
WSC Phone
(###)
###
####
Photo Release
I Allow Photographs Of My Child To Be Used For Public Relations And Archival Purposes
Yes
No
Emergency Contact
First Name
Last Name
Emergency Phone
(###)
###
####
Check all that apply:
I am concerned about my eating habits
I am concerned about my weight
I am unable to control my behavior and/or thoughts
I am easily moved to tears
I am easily distracted
I am easily moved to anger and/or aggression
I am concerned about sexual issues
I am upset about a recent death
I am concerned about a recent break up or finding a significant other
I am depressed
I feel tired much of the time
I feel anxious and worried much of the time
I have obsessive/compulsive patterns
I have mood swings
I have a need to move around the room often
I have difficulty opening up and trusting people
I do not adjust well to new situations
Please elaborate:
What service ratio is required?
1:1
1:3
1:5
1:10
Toileting
*
I am able to toilet independently.
Yes
No
Please choose one:
I require adaptive equipment and have the equipment I need.
I do not require adaptive equipment.
Needs and Interests
*
Communication:
Verbal
Hands/Gestures
Sign Language
Written word
Photos/Picture board
Cultural Interests:
Drawing/Illustration
Graphic Design
Animation
Photography
Ceramics
Sculpture
Mixed Media
Music
Theater
Dance
Writing
Videography
Other, please list:
Hobbies:
Reading
Watching TV
Family Time
Going to the Movies
Fishing
Computer
Gardening
Walking
Running
Biking
Golf
Swimming
Tennis
Team Sports
Boating
Listening to Music
Shopping
Socializing
Sewing
Knitting/Crocheting
Church Activities
Playing Games
Cooking
Animal Care
Bowling
Beach
Visual Arts
Performing Arts
Billiards
Other
If Other, please list:
Employment
*
I have a job.
I would like to have a job.
I am not interested in having a job.
I might be interested in having a job.
Today's Date:
MM
DD
YYYY
*
By checking this box, I understand that no aggressive behaviors will be tolerated at Creative Clay and can result in expulsion from the program.
Liability Release
*
With regards to the applicant named above, I, the undersigned parent or legal guardian, do hereby release Creative Clay, Inc. or any person acting on its behalf from liability for any bodily injury sustained, or loss or damage of any personal items, while on the premises or participating in any activity sponsored by Creative Clay, Inc. Furthermore, the undersigned agrees that in the event that medical attention is needed due to accident or illness, Creative Clay, Inc., shall be permitted to seek medical services as it shall be deemed necessary and appropriate through EMS/911 and/or local hospitals.
By checking here, I agree to the above liability release.
Thank you!