Member Registration Demo1 - Break the Barrier Software

Select Membership

Community Artist - $0.00

This is the default membership for all new program applicants/registrants. Community Artists participate in Performing Arts or Special Projects programming. If a Community Artist is interested in Visual Arts Programming, they will need to have their membership updated to either PDD or AE. The Community Artist membership type does not require admin approval has no annual membership fee.

PDD Artist - $5.00

To be eligible for this membership type you must receive PDD supports. PDD Artists participate in our main studio Visual Arts Programming. This membership type requires admin approval and a referral from the individual’s PDD caseworker as spots are limited. There is an annual $5 membership fee associated with this type.

AE Artist - $5.00

The AE Artist membership is for individuals who have a physical disability, or a disability acquired later in life. These individuals do not receive any PDD supports. AE Artists participate in our main studio Visual Arts Programming. This membership type requires admin approval as spots are limited. There is an annual $5 membership fee associated with this type.

Member Information

First Name: *

Last Name: *

Preferred Name:

Pronouns:

Please check the preferred method of contact:

Email: *

Primary Phone: *

Secondary Phone:

Address Search: *

City: *

Province: *

Postal Code: *

Country: *

Which of the following apply to you? *

PDD Number: *

Primary Service Agency:

PDD Coordinator First Name: *

PDD Coordinator Last Name: *

PDD Coordinator Phone Number:

PDD Coordinator Email:

PDD Coordinator Address:

PDD Coordinator City:

PDD Coordinator Province:

PDD Coordinator Postal Code:

PDD Coordinator Country:

ISP Contact First Name:

ISP Contact Last Name:

ISP Contact Phone Number:

ISP Contact Email:

ISP Contact Address:

ISP Contact City:

ISP Contact Province:

ISP Contact Postal Code:

ISP Contact Country:

ISP Month: *

Emergency Contact

Emergency Contact First Name: *

Emergency Contact Last Name: *

Emergency Contact Relationship: *

Emergency Contact Phone Number: *

Emergency Contact Secondary Phone Number: *

Health Profile

Date of Birth: *

Please list all known allergies:

Please list all known medications:

Describe any existing medical conditions we should be aware of:

Desribe any assistive technology you/the artist use:

Support Network

Guardianship: *

Public Guardian First Name: *

Public Guardian Last Name: *

Public Guardian Phone Number: *

Public Guardian Email: *

Public Guardian Address: *

Public Guardian City: *

Public Guardian Province: *

Public Guardian Postal Code: *

Public Guardian Country: *

Guardian First Name: *

Guardian Last Name: *

Guardian Phone Number: *

Guardian Email: *

Guardian Address: *

Guardian City: *

Guardian Province: *

Guardian Postal Code: *

Guardian Country: *

Guardian Relationship: *

Trusteeship: *

Public Trustee First Name: *

Public Trustee Last Name: *

Public Trustee Phone Number: *

Public Trustee Email: *

Public Trustee Address: *

Public Trustee City: *

Public Trustee Province: *

Public Trustee Postal Code: *

Public Trustee Country: *

Trustee First Name: *

Trustee Last Name: *

Trustee Phone Number: *

Trustee Email: *

Trustee Address: *

Trustee City: *

Trustee Province: *

Trustee Postal Code: *

Trustee Country: *

Trustee Relationship:

Do you/the artist have any restrictive protocols in place?: *

Yes

No

Describe your restrictive protocols here:

If we need to call home, please indicate who we should speak to: *

Home Contact First Name: *

Home Contact Last Name: *

Home Contact Relationship: *

Home Contact Phone Number: *

Home Contact Email: *

Home Contact Address: *

Home Contact City: *

Home Contact Province: *

Home Contact Postal Code: *

Home Contact Country: *

Will you/the artist be taking Access Calgary to get to and from the BTBS? *

Yes

No

Access Calgary ID Number: *

Password: *

Is this a "Hand Over" client?: *

Yes

No

Will you/the artist attend the BTBS with a support worker? *

Yes

No

Support Worker First Name:

Support Worker Last Name:

Will the support worker be supporting only the artist, or multiple people? *

Yes

No

Additional Notes Pertaining To Support Worker:

Additional Details:

Invoicing and Permissions

How shall we invoice you/the artist for completed projects?

Where should we send your invoices?

Recipient First Name: *

Recipient Last Name: *

Recipient Phone Number: *

Recipient Email: *

Recipient Address: *

Recipient City: *

Recipient Province: *

Recipient Postal Code: *

Recipient Country: *

Artist Agreement (PDF)

I have read and agree to the Artist Agreement

Consent to Release Information (PDF)

I give consent for National accessArts Centre to release my information

Exhibitions, Sales, Publicity, and Digital Participation (PDF)

I give consent for National accessArts Centre to use photos or video captures of the artists and/or their works for exhibition and publicity purposes

Yes No

I give consent for the artist to participate in any digital programming

Yes No

I give consent for the artist to create their own profile on the artjourney platform and for the BTBS to assist the artists with the creation of their profile

Yes No

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