1. education
2. high school

High school students
ages 13 to 18
are invited to join us
for this all-night
avant garde teen lock-in
presented by MOCAD’s
Teen Council.
art making,
d Prizes,
video-games, movies, and more!
Bring a sleeping bag, pillow,
d toothbrush,
tooth paste,
activewear, sleepover sweats,
and a friend!
d Morning breakfast will be served.
*
Pre-registration required.
MUSEUM OF
CONTEMPORARY
ART DETROIT
4454 Woodward Ave,
Detroit MI 48201
uncil is
The MOCAD Teen Co young
a select group of o
tr
creatives from me
e
th
d
Detroit an
surrounding areas. e
These teens receiv to come
monthly honoraria d with
together, plan, an
the help of museum uce
professionals, produth and
programming for yo MOCAD.
e
adults here at th
For more information, contact
Youth Program Producer,
Tylonn J. Sawyer at 313.832.6622
or email: [email protected]
mocadetroit.org
slip
(permission
on reverse side)
MOCAD Youth programs are graciously funded by the GM Foundation and the Knight Foundation. Exhibition programming support is generously provided by
the Taubman Foundation. Additional funding for programming and educational initiatives is provided by the Edith S. Briskin/Shirley K. Schlafer Foundation.
Additional support is provided by The Michigan Council for Arts and Cultural Affairs and the National Endowment for the Arts
MIDNIGHT
MOCAD
TEEN
LOCK IN
PARENT/GUARDIAN
PERMISSIONS FORM
2015 at 8pm
UNTIL
SATURDAY
MAR. 28
2015 at 9:30am
/
/
Month / Day / Year
THE DETAILS:
Guardians must accompany teens to the door and are invited to stay with their teen
but are not required to, if you plan on leaving please fill out the following information, and schedule a pick up time with your teen between 6-9:30am.
18+ must show ID if unaccompanied by guardian.
I:
FULL LEGAL NAME
FRIDAY
MAR. 27
Today’s Date:
(print name
+
PARENT/GUARDIAN PERMISSIONS
signature of parent/guardian):
ADDRESS:
TELEPHONE NUMBER: (
)
To attend Midnight MOCAD TEEN LOCK IN 2015, a special event for high school students only, at MOCAD. I understand that this event
begins at 8:00PM on Friday, March 27, 2015 ,and ends at 9:00AM on Saturday, March 28, 2015. I understand that during the event
artwork with adult content will be open to all attendees. I accept full responsibility for my teenager’s transportation to and from MOCAD,
and understand that once doors are closed for the Midnight MOCAD TEEN LOCK IN 2015 my teen will not be allowed to leave until 9AM
on March 28, 2015, unless a medical or personal emergency arises and a parent/guardian is present.
–
SIGNATURE:
I grant my authorization and consent for Tylonn Sawyer and/or a MOCAD employee (hereafter “Designated Adult”) to administer general
first aid treatment for any minor injuries or illnesses experienced by the minor. If the injury or illness is life threatening or in need of
emergency treatment, I authorize the Designated Adult to summon any and all professional emergency personnel to attend, transport, and
treat the minor. I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in
advance of any such medical treatment, but is given to provide authority and power on the part of the Designated Adult in the exercise of
his or her best judgment upon the advice of any such medical or emergency personnel.
Give my permission for:
FULL LEGAL NAME (print minor child name):
ADDRESS:
TELEPHONE NUMBER: (
Date of Birth:
/
)
/
I grant to MOCAD the right to take photographs of my teenager in connection with Midnight MOCAD TEEN LOCK IN 2015. I authorize
MOCAD, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that MOCAD may use
such photographs with or without his or her name and for any lawful purpose, including for example such purposes as publicity,
illustration, advertising, and Web content.
–
High School Name:
I knowingly and intentionally waive and hereby release any and all claims to liability for all injuries, illnesses, or property damage against
MOCAD, its trustees, agents, and employees that I or my representatives may have by reason of my minor’s participation in Midnight
MOCAD TEEN LOCK IN 2015.
Month / Day / Year
Grade Level:
Emergency Contact:
All age High School students are welcome!
MUSEUM OF
CONTEMPORARY ART DETROIT
4 4 5 4 Wo o d w a r d Ave
Detroit, MI 48201
High school students ages 13 to 18 are
invited to join us for this all-night avant
garde teen lock-in presented by MOCAD’s
Teen Council. Trivia, prizes, art making,
video games, movies, and more! Bring a
sleeping bag, pillow, toothbrush, tooth
paste, activewear, sleepover sweats, and a
friend! Morning breakfast will be served.
Pre-registration required.
Phone Number: (
)
–
Primary Care Physician:
(name & telephone number)
For more information,
contact:
Youth Program Producer
Tylonn Sawyer at:
313.832.6622
or
[email protected]
Ph on e 3 1 3 . 8 3 2 . 6 6 2 2
Fax 3 1 3 . 8 3 2 . 4 6 6 5
[email protected]
w w w. m o c a d e t r o i t . o r g
The MOCAD Teen Council is a select group of young creatives from metro Detroit and the
surrounding areas. These teens receive monthly honoraria to come together, plan, and
with the help of museum professionals, produce programming for youth and adults here at
the MOCAD.
MOCAD Youth programs are graciously funded by the GM Foundation and the Knight Foundation. Exhibition programming
support is generously provided by the Taubman Foundation. Additional funding for programming and educational initiatives
is provided by the Edith S. Briskin/Shirley K. Schlafer Foundation. Additional support is provided by The Michigan Council for
Arts and Cultural Affairs and the National Endowment for the Arts
Medical Insurer/ Health Plan:
Policy Number:
Allegies:
Medical Problems:
Present Medications:
Signature:
This authorization is effective through:
. Signed this
day of
, 2015