The Wellness Collective Community Programming Registration Form
The Wellness Collective invites youth and community members to join our 3-month Cultural Performance Program designed to celebrate creativity, culture, and leadership. For just $50 per month, participants can explore:Music Lessons (voice & instruments)Creative Writing & StorytellingMardi Gras Indian Beading (traditional artistry)Visual Art & DesignTheater & Acting (stage skills & performance)Leadership Development (teamwork & self-expression)Through weekly classes led by professional artists and culture bearers, participants gain hands-on skills, mentorship, and performance opportunities. The program fosters cultural pride, creativity, and confidence while preparing youth to be leaders in both the arts and their communities.Spaces are limited—reserve your spot today and become part of a program where tradition, innovation, and performance come together!
Participant Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Gender
Date of Birth (DD/MM/YYYY)
Age
*
Parent/Guardian Name
*
First Name
Last Name
Participant Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which of our programs are most interested in? (2 maximum)
*
Music Lessons (voice & instruments)
Creative Writing & Storytelling
Mardi Gras Indian Beading (traditional artistry)
Visual Art & Design
Theater & Acting (stage skills & performance)
Leadership Development (teamwork & self-expression)
What is your primary language?
*
Please Select
English
Spanish
Other
Which best describes your race/ethnicity? ( Select all that apply)
Please Select
African American/Black
Hispanic/Latino
Caucasian/White
Asian/Pacific Islander
Native American
Other
How did you hear about our programs?
Please Select
Social Media
Word of Mouth
School/Teacher
Community Event
Other
Would you be interested in receiving information about additional events, workshops, or volunteer opportunities?
Please Select
YES
NO
Does your household receive any of the following benefits? (SNAP, WIC,TANF,SSI,Medicaid,Low Income Housing)
Please Select
YES
NO
By checking this box, I understand that my/our participation in The Wellness Collective’s programming may involve being photographed or filmed. I grant The Wellness Collective permission to use photos or videos of me/my child taken during events for promotional and marketing purposes, including social media and print. I understand that these images are property of The Wellness Collective and will be used without compensation.( Must check box to submit form)
*
Submit
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