Spring 2023 Registration

Register for Spring 2023!
Thank you for your interest in Lake Erie Ink's creative expression programs for youth.

The information we collect in this registration form will be saved for future registrations through May 2023.

Payment for workshops can be made via our DONATE button on the website, or by check to Lake Erie Ink: 2843 Washington Blvd. Cleveland Heights, OH 44118. Scholarships are available for all programs.

If we cancel a class session due to low enrollment, you will receive a full refund. However, we cannot refund money for a session that you are not able to attend. We can give you credit for another session.

You will receive program details and zoom links for virtual workshops a week prior to the session via email. If you have any questions, please call 216-320-4757. Thank you!
Parent/Guardian Email Address*
example@example.com
Student Name*

First NameLast Name

Please Choose Which Program(s) the Participant would Like to Attend:
Weekend Ink

Saturdays, 10am-12pm, $10 each
January 28th: Playwriting at Dobama TheaterFebruary 4th: Playwriting at Dobama Theater
Events
May 6th, 12:30-3:30pm: Teen Writers' Symposium at CSU, FREE
Evening Ink
Virtual Programs
Comic Journaling | Tuesdays | 6th-12th grade | 6:30-8pm | January 31-April 11 | $135

Writers Club | Wednesdays | 4th-12th grade | 6:30-8pm | February 1-May 3 | $180

College Essay Workshops | Wednesdays | 6:30-8pm | $10 per session

February 1

February 8

February 15

February 22

March 1

March 8

March 15

Note: The Screenwriting program has been cancelled.
Please select your virtual Evening Ink programs below:
In Person
LGBTQ+ Writers' Studio | Twice a month on Mondays | @ LEI | 6th-12th grade | 6-7:30pm | January 23-May 8 | FREE

dates: 1/23, 1/30, 2/13, 2/27, 3/6, 3/13, 4/17, 4/24, 5/1, 5/8

Poets and Pizza | Twice a month on Fridays | @ LEI | 8th-12th grade | 6:30-8:30pm | January 20-May 26 | FREE

dates: 1/20, 2/3, 2/17, 3/10, 3/24, 4/7, 4/21, 5/12, 5/26

Dungeons and Dragons | 10 meetings per session | Each session $150

Session 1

Wednesdays | 4-6pm | 6th-12th grade | January 18-March 22

Session 2

Mondays | 6-8pm | 8th-12th grade | April 3-June 5

Wednesdays | 4-6pm | 6th-12th grade | April 5-June 7

Fridays | 4-6pm | 4th-8th grade | April 7-June 9

Please only select ONE D&D program per session.
Please select your in person Evening Ink programs below:
Please select your D&D session(s) below:

Session 1 / WednesdaysSession 2 / MondaysSession 2 / WednesdaysSession 2 / Fridays

Have you registered for a program since June 2022?*

YesNo

Has any of your information changed since then?*

YesNo

Participant Information
Student Birthdate*

MonthDayYear
Date
Student Pronouns (she/her, he/him, they/them, etc.)
Student School*
Student Grade for the 2022-2023 School Year*
Student Home Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Demographic Information

The following demographic questions help Lake Erie Ink report and apply to funders upon request. All information will remain confidential.
What is your child's ethnicity?*

AsianBiracialBlack or African AmericanHispanic or LatinoNative American or AlaskanPacific Islander or HawaiianWhite or CaucasianPrefer not to answerOther
What is your child's first language, if not English?

Parent/Guardian and Emergency Contact Information
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Cell Phone*
Please enter a valid phone number.
Parent/Guardian Relationship to Child
Parent/Guardian Email*
example@example.com
Second Parent/Guardian Full Name

First NameLast Name
Second Parent/Guardian Relationship to Child
Second Parent/Guardian Cell Phone
Please enter a valid phone number.
Second Parent/Guardian Email
example@example.com
Alternate Emergency Contact:

First NameLast Name
Alternate Emergency Contact Phone Number:
Please enter a valid phone number.
Alternate Emergency Contact Relationship to Student:

Learning & Medical Concerns
Please describe any special learning concerns you might have for your child:
Please describe any medical or health concerns (i.e. allergies, asthma, diabetes, etc.):
In the event that the individual(s) listed above cannot be reached in an emergency, I hereby give my consent for emergency medical treatment by a licensed professional and the transfer of my child to a local hospital.*

YesNo

Pickup Information
Does your child have permission to leave on their own (walk, bike, drive, etc.) at the conclusion of the program?*

YesNo
If anyone other than the parents/guardians listed above will be picking up your child, please enter their full names and phone numbers below:
Liability Release: I understand and agree that Lake Erie Ink: A Writing Space for Youth (hereafter “LEI”) is not responsible for supervising my child or for my child’s safety after the end of the program, and that neither LEI nor any of its staff members is liable for any physical or emotional harm to my child, caused by my child’s negligence or by the negligence, intentional act or criminal act of a third party, nor for any property or damage or loss caused by my child.*

YesNo

Permissions
Student email which will be used during virtual programs.
example@example.com
Please check the box below confirming that you understand that Lake Erie Ink teachers are collecting emails to be able to communicate with your child about the workshops using online means (email or Zoom platform). If you have any questions or concerns please email: cbailey@lakeerieink.org*

YesNo
I give permission to Lake Erie Ink to photograph/videotape my child while participating in program activities. These photos or videos may be used to promote Lake Erie Ink programs.*

YesNo
I give permission for Lake Erie Ink: a writing space for youth to publish my student’s work in any Lake Erie Ink publication, including our student anthologies, website, social media, blog, vlog, or podcast, using my first name, last initial, and age/grade.*

YesNo
Freedom of Expression Policy: Lake Erie Ink believes in freedom of speech and respects the right of all participants to express themselves honestly and creatively. However, we reserve the right to contact parents/guardians/school authorities if we feel the content of a participants work suggests possible harm to self or others. I have read and consent to the Lake Erie Ink Freedom of Expression policy:*

YesNo
Parent/Guardian Signature*

Clear
Student Signature:*

Clear

Register for Spring 2023!

Please Choose Which Program(s) the Participant would Like to Attend:

Weekend Ink

Events

Evening Ink

Virtual Programs

In Person

Participant Information

Demographic Information

Parent/Guardian and Emergency Contact Information

Learning & Medical Concerns

Pickup Information

Permissions

Payment

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