Apply to be a Member Artist

Use the form below to become a Creative Clay Member Artist

Please complete the form below

Name *
Name
Date of Birth
Date of Birth
Phone Number *
Phone Number
Mailing Address
Mailing Address
Support Coordinator
Support Coordinator
WSC Phone
WSC Phone
Photo Release
I Allow Photographs Of My Child To Be Used For Public Relations And Archival Purposes
Emergency Contact
Emergency Contact
Emergency Phone
Emergency Phone
Behavioral Concerns
Check all that apply:
Please elaborate:
What service ratio is required?
Toileting *
I am able to toilet independently.
Needs and Interests *
Communication:
Cultural Interests:
Hobbies:
Employment *
Today's Date:
Today's Date:
Liability Release *
With regards to the applicant named above, I, the undersigned parent or legal guardian, do hereby release Creative Clay, Inc. or any person acting on its behalf from liability for any bodily injury sustained, or loss or damage of any personal items, while on the premises or participating in any activity sponsored by Creative Clay, Inc. Furthermore, the undersigned agrees that in the event that medical attention is needed due to accident or illness, Creative Clay, Inc., shall be permitted to seek medical services as it shall be deemed necessary and appropriate through EMS/911 and/or local hospitals.