2024 Artist Residency Form

Summer Artist Residency Form

Fill out the form carefully and reach out to michael@insight-photography.org with questions
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Pronouns*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Youth's Email
example@example.com
Parent/ Guardian's Email*
example@example.com
Youth's Phone Number
Parent/ Guardian's Phone Number*
Which email and phone number should we use to share information about class?*

Youth onlyParent/ Guardian OnlyBoth
Tell us about your project idea! Let us know if you need help!*
Examples of Your Artwork*

Cancelof
Emergency Contact*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.
Anything we should know about this student? Allergies, sensitivities, etc.
Our programs are made possible through grants and the generosity of our community. Please help us collect the needed data to demonstrate our community's need for financial support to our programs. Select all that apply. All information is confidential and it is optional to share. Thank you!

The student/student's family qualifies for aid such as SNAP food assistance (3SquaresVT), Medicaid, Section 8 housing assistance.At least one legal guardians serves/has served in the armed forces.The student is in foster care or has been in foster care.The student has limited English proficiency.The student is houseless or at risk of being houseless.At least one legal guardian is currently serving time, or has served a period of time, in jail or prison.The student is at risk of not completing high school.The student is eligible for free or reduced lunch at school.The student regularly uses public transportation.The student does not have access to adequate broadband internet at home.
Household Income

$0 - $50,000$50,000 to $100,000$100,000 to $150,000$150,000 +
In-Sight has permission to use images of the participant to promote and market In-Sight Photography Project and it's mission. We will not use a student's full name with the image.*

YesNo
In-Sight has permission to use images produced by the student to promote and market In-Sight Photography Project and it's mission. We will give credit to a student for their work, but will not use a student's full name.*

YesNo
Class Safety

As the parent/ guardian of the student enrolled in In-Sight's class, I agree to take full responsibility for the safety of the student participating. I recognize that In-Sight will do its best to teach all participants the art of photography with as much care and safety as is reasonably possible. In-Sight's staff and volunteer instructors will take reasonable care and precautions to maintain student safety. As accidents do happen, we agree not to hold In-Sight, its staff, or volunteers legally responsible for the safety of the participant. If a student cannot meet the safety expectations, In-Sight will have to reconsider class participation.

Downtown Travel

In-Sight Photogarphy Project's central, downtown location allows for our classes to often leave the premises and take photos around town, weather permitting. This may include visiting the Brattleboro Museum and Art Center, Vermont Center for Photography, other galleries, and public spaces in the immediate downtown area. Your student's safety is of utmost importance, and students will remain within seeing and hearing range of instructors. If any class plans to leave the downtown area, we will notify your in advance with more details about each field trip.

Equipment Release

In-Sight Photogarphy Project provides all of the equipment for each class and students are able to borrow equipment from In-Sight in order to practice and grow their skills. However, they can also use their own! If you have questions about whether or not your personal camera will work for a class, please contact Program Director, Michael Zuhorski, michael@insight-photography.org, before the start of class.

Parents/ guardians and students take full responsibility for the photographic equipment students borrow from In-Sight Photography Project. Anything lost or broken will need to be replaced. We expect equipment to be returned at the end of the last class unless other arrangements are made.

Content Disclaimer

Art is expressive and can sometimes elicit intense emotions. It is the priority of In-Sight staff and instrucotrs to make the classroom a welcoming space for all students by managing these topics appropriately. We will not allow nudity or depictions of harm to be show in the classroom.

Additionally, if a student makes an In-Sight staff member aware of abuse or neglect, it is our responsibility as mandated reporters to share this information with Vermont DCF.

By signing below, you are indicating that you have read and agree to the ablove.
Signature*

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Chose the Fee to Pledge Per Class*
Total Pledged Class Fees (if taking more than 1 class, multiply number of classes by the pledged fee chosen above) *
I plan to pay using my

Credit Card/ PayPalChecking AccountCash
50 % of Pledged Class Fees Registration Deposit

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USDIn-Sight asks for a deposit of 50% of the total pledged amount. The deposit pays for the preparation of the class: staff time, equipment, and supplies. In most cases we cannot refund deposits, but we can transfer funds for one class to another. An invoice will be sent in advance of the class and the remaining pledged fee is due the week of your student's class. We will not turn a student away for lack of family funds. Please contact Program Director Michael, michael@insight-photography.org, if you have questions.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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Summer Artist Residency Form