Summer Art Academy Membership Interest Form

Who Qualifies for Our Community Pass?

This form is for families who may qualify for our FREE Community Pass at Modern Party Art's Dorchester location. To qualify, your household must be considered low income and at least one of the following must apply to your child:

🏥 If your child has MassHealth — select MassHealth FIRST. This is the most important option and unlocks the most benefits, including free days. Even if you also have EBT or WIC, please make sure MassHealth is selected.
🛒 Your household receives EBT (SNAP/Food Stamps)
🍼 Your household receives WIC benefits
💛 Not sure which to choose? If your child has MassHealth, always lead with that — you can select additional options too, but MassHealth must be checked to receive the full Community Pass benefits including free days.

Please note: Modern Party Art is an art program for youth ages 5–12. We are not EEC certified and do not accept childcare vouchers. This form does not guarantee enrollment — qualifying families will be contacted directly. Limited to 20 memberships per year at our Dorchester location only.

First Name

Last Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Neighborhood/City

Child’s First Name

Child’s Age

Child’s Date of Birth

Date

Child's Gender

Which program(s) are you interested in?

Does your household qualify as low income?

Do you currently receive any of the following benefits?

Mass Health Policy Number

You can find this on your Mass Health card or benefits letter.

By submitting this form, you are saying "I understand that Modern Party Art is not EEC certified, does not accept vouchers, and that submitting this form does not guarantee enrollment. I confirm the information above is accurate."

Low-Income Summer Art Academy and After-School Programming Inquiry

Parent/Guardian Information

Child Information

Income Qualification