REGISTRATION 2015 (PDF)

YOUNG ARTIST’S INFORMATION
Artist’s Last Name

Artist’s First Name

Initial

Date of Birth

Gender

Age as of Beginning of Session

Health Card #

Doctor’s Name

Doctor’s Phone #

PARENT INFORMATION
PARENT/GUARDIAN #1
Last Name

First Name

ADD TO PICK UP LIST?

Home address

City

YES/ NO
Postal Code

Home #

Work #

Cell Phone #

PARENT/GUARDIAN #2
Last Name

First Name

ADD TO PICK UP LIST?

Home address

City

YES/ NO
Postal Code

Home #

Work #

Cell Phone #

EMERGENCY INFORMATION
Last Name

First Name

Relationship to Child

Home #

Work #

Cell Phone #

DO WE HAVE AN UP TO DATE MEDICAL/BEHAVIOURAL PROFILE OF YOUR CHILD? YES

NO

SIGNATURE OF PARENT___________________________________________ DATE __________________________

SESSION SELECTION – AFTER SCHOOL, MARCH AND SUMMER CAMP
CIRCLE DAY(S)
MONDAY
WEDNESDAY
FRIDAY

SCHOOL NAME

SCHOOL ADDRESS/DISMISSAL INFO

TUESDAY
THURSDAY
ALL

MARCH BREAK YES

NO (CIRCLE)

SUMMER CAMP? REGISTRATION WEEKS BEGINNING (CIRCLE WEEKS):
JULY 7, JULY 14, JULY, 21, JULY 28, AUGUST 5, AUGUST 12, AUGUST 17
SPECIAL INSTRUCTIONS AND NOTES FOR PROGRAMMING CONSULTANT(ANYTHING YOU THINK WE SHOULD
KNOW ABOUT YOUR YOUNG ARTIST):

SESSION INFORMATION
After-school programming for children aged 6 to 12
A walk-to program is available to children at eligible schools that demonstrate a strong interest in
participating: Duke, Roden, Equinox, Leslieville and Bowmore Public Schools. Children will be picked up at the
end of school and walked to the Gallery, where they will be offered a nutritious snack, complete homework
and participate in scheduled art and recreational programming that rotates on a weekly basis.
ROTATING ACTIVITIES FOR AFTER SCHOOL SCHEDULE
MONDAY:
TUESDAY:
WEDNESDAY:
THURSDAY:
FRIDAY:

MATH AND SCIENCE IN ART
BASICS OF DRAWING, USE OF COLOUR
PAINTING IN ACRYLICS, WATER COLOURS AND PASTELS
PEOPLE/PORTRAITS/LANDSCAPES/STILL LIFE
ARTS AND CRAFTS /USING FOUND OBJECTS/SEASONALLY INSPIRED CRAFTING

MARCH BREAK AND SUMMER CAMP PROGRAMMING
All-day programming, offered at Spring break, in the summer and during Toronto District School Board and
Toronto Catholic District School Board Professional Development days, runs from 8.30 AM until 6 PM. The
programming emphasizes artistic activities each morning, including some more formal instruction in acquiring
basic drawing skills, composition and colour theory. After lunch, our young artists will enjoy some more light,
artistically driven activities following some of the other themes outlined above; time outside and wind-down.
Young artists should bring their own lunches and will be served a nutritious, nut-free snack twice a day. Pick
up takes place between 5.30 and 6.
CONTACT INFORMATION
Rebellion Gallery and Art Academy, 1495 Gerrard Street East, Toronto, Ontario M4L 2A4
PHONE: (416) 469-1777; Email: Stacey@rebelliongallery.ca