Creative Minds: Fiber Arts and Disability Registration Form

Creative Minds: Fiber Arts and Disability Registration Form
ABOUT THE PROGRAM

Creative Minds is a program series offered by North York Arts. Each season, North York artists facilitate programming with a unique focus that prioritizes wellness through thematic explorations, the presence of an active listener, and accessibility accommodations available upon request within capacity. Artist and Disability advocate Liz McCready will be facilitating a workshop on how to create a service dog tote bag. Through teaching fiber arts like crochet through the use of accessible tools and techniques
This registration will take around 10 min to be filled out. If you require any assistance or have any questions please email programs@northyorkarts.org or call 647-477-6059 and leave a voice message for Declan.
Creative Minds: Fiber Arts and Disability

Date: October 11th

Time: 11:00am - 3:00pm

Location: Meeting Room 101 - North York Centre Library, 5120 Yonge St, North York, ON M2N 5N9
CONTACT INFORMATION
Name

First NameLast Name
Prefered Name
Age Range
Are You Under The Age of 18?
Parent/Guardian Name (Fill 'N/A' if over 18)

First NameLast Name
Parent/Guardian Phone Number
Please Enter a Valid Phone Number
Parent/Guardian Email
Please Enter a Valid Email Address
Pronouns:

Other
Postal Code
Area you live in:

Other
Please note that spots are limited and priority will be given to North York residents.
Personal Email
example@example.com
Phone number
Please provide the best number for NYA staff to reach youFormat: (000) 000-0000.
Emergency Contact
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
PROGRAM QUESTIONS
Do you identify as Deaf/Disabled?
Do you identify as a Newcomer (immigrated to Canada less than 7 years ago)?
Which of the following best describes your gender identity? (Select all that apply)
Please tell us if you have specific access needs in order to participate in this program:
Why are you interested in this program?:
OUTREACH QUESTIONS
How did you hear about the program?

Other
If other, please specify. Use N/A if you already selected an option.
Did you know about North York Arts before this program?
Would you like to learn more about volunteer opportunities at North York Arts?
Would you like to subscribe to our monthly e-newsletter? You will receive updates about upcoming NYA programming, news, and community updates.
SECTION 5: DATA COLLECTION
Why are we collecting this data? North York Arts is strongly committed to equity and inclusion in our programs. With this in mind, we have set out specific programming goals in our strategic plan to better serve our communities. To ensure that we do so, we are collecting data on how our participants self-identify. This is completely optional but we appreciate your input, if you prefer not to disclose chose the option Prefer not to disclose.
Gender Identity (select all that apply)

Other
Ethnicity & Race (select all that apply) If you’re comfortable, we encourage you to be specific about how you identify, this helps North York Arts better serve our communities.

Other
Are you a Newcomer, Refugee, or Immigrant to Canada? (select all that apply)

Other
Do you identify as a person part of the 2SLGBTQ+ community?
Do you identify as part of the Deaf and Disabled community?
PHOTO RELEASE AND SOCIAL MEDIA CONSENT FORM
At North York Arts, part of our marketing strategy involves creating an online presence through content generation on our website and social media channels, as well as producing other forms of marketing materials.

We are respectful of the privacy of our employees and the public at large. Therefore we wish to obtain your express consent to produce images, videos of you, or testimonials from you for marketing purposes.
Using the boxes below, please indicate your consent for the organization to use photos, videos or testimonials of you in marketing materials, such as those listed above.

I consent to having images or videos of me and/or testimonials related to North York Arts be used for marketing purposes such as presentations, promotions, or other similar manners of publication. I understand that the material provided by me may be condensed, edited or summarized as needed by North York Arts. My consent is freely given to North York Arts as a public service, and I am aware that I will not be compensated for the use of the photograph(s), image(s), and/or testimonials. I hereby release North York Arts, its officers, employees, and agents from any and all claims for harm or liability arising from any distortion, blurring, or alteration, optical illusion, or use in composite form, whether intentional or unintentional. I understand that I have the right to revoke this authorization at any time by writing to North York Arts. Any actions taken prior to receipt of this written notification will be unaffected by the revocation.
Land Acknowledgment

North York Arts Statement
NYA's vision is to create an inclusive, equitable, engaged and sustainable arts community in North York. In addition to featuring amazing art programming our programs and events sometimes include acknowledgements or programming elements that are important to the work we do and speak towards our vision.

Land acknowledgments are an important part of our commitment to the calls to action in the Truth and Reconciliation Act and recognizing the role that art has in the decolonization process and building right relations with Indigenous communities.

Please note that at the beginning of our programs and events, a North York Arts representative, invited artist, or community member might be starting with an acknowledgement.
Funded by
Personal Information and Privacy Act (PIPA) Statement

We collect only the personal information that we need for the purposes of providing services to our clients. We protect personal information in a manner appropriate for the sensitivity of the information. We make every reasonable effort to prevent any loss, misuse, disclosure or modification of personal information, as well as any unauthorized access to personal information
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Creative Minds: Fiber Arts and Disability Registration Form

ABOUT THE PROGRAM

CONTACT INFORMATION

Emergency Contact

PROGRAM QUESTIONS

OUTREACH QUESTIONS

SECTION 5: DATA COLLECTION

PHOTO RELEASE AND SOCIAL MEDIA CONSENT FORM

Land Acknowledgment

Funded by