Strokes for a Cause Registration

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Strokes for a Cause
This is Telic Empowerment's annual art education event! This event encourages amateur artists with disabilities that have an art talent or interest to let their talents shine! A skilled art instructor will conduct a unique art class that focuses on a theme. All attendees will be allowed to freely paint their own original masterpiece within the theme. All disabilities are welcome. Participants will not be able to keep the art work created at this event, but will be given a keepsake with their art piece. All pieces of artwork will be included in our "The Art of Ability" art auction, held in the fall. All participants and their families will be invited to attend the auction as our special guests. Strokes for a Cause is limited to individuals with disabilities from the age of 7 to 30. An able bodied adult (21 and older) is required to stay with each attendee. There is limited space available. To hold your spot, pay a $5.00 REFUNDABLE fee using the donate button at the bottom of this page. This year, 2022, we will have Strokes for a Cause outdoors at Wheeler Park in Conyers on July 16th, from 11-1 pm.
Parent's First Name^*
Your First Name Here
Parent's Last Name^*
Your Last Name Here
Phone Number^*
mobile number
Email^*
A good contact email address
County of Residence
Artist Name^*
Name of the disabled artist
Type of Disability^*
Place Artist's Primary Disability here
Age of Artist
Age of Artist
Number of Siblings Attending The Event
We can accommodate up to 2 siblings in addition to the participant, if needed.
Name of Chaperone^*
Age of Chaperone (required)
The chaperone is 21 or older.

Age of Chaperone
Special Instructions
Waiver (required)^*
Telic Empowerment has my permission to photograph and videotape the artist and/or chaperone. I understand the completed artwork will be the property of Telic Empowerment and will be auctioned off at a later date. The artist will receive a keepsake with their art piece and will be invited to our "The Art of Ability" art auction. Each artist must be chaperoned and the chaperone must remain for the entire art class. We only accept disabled artists from the age of 7 to 30. Space is limited. Registration is not a guarantee of acceptance into art class. You will receive a confirmation email stating that your registration has been accepted. Telic Empowerment is not responsible for any hurt, harm, or illness that occurs during this event.
I Accept
Covid Disclosure Agreement (must scroll to continue)^*
Individuals who currently or within the past fourteen (14) days of the event who have experienced any symptoms associated with COVID-19, which include fever, cough, and shortness of breath and individuals who believe that they may have been exposed to a confirmed or suspected case of COVID-19 or have been diagnosed with COVID-19 and are not yet cleared as non-contagious by state or local public health authorities or the health care team responsible for their treatment are responsible for notifying Telic Empowerment at info@telicempowerment.org and are strongly urged to not attend for the safety of the other participants and their families.
I understand and will comply.
Covid Liability Waiver (must scroll down)^*
I acknowledge and understand the following: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; 2. I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19, even if arising from the negligence or fault of the Telic Empowerment and its affiliates; and 3. I hereby knowingly assume the risk of injury, harm and loss associated with attending Strokes For A Cause, including any injury, harm and loss caused by the negligence, fault or conduct of any kind on the part of the Telic Empowerment and affiliates.
I acknowledge and understand
Duty to Inform (must scroll down)^*
Participants agree to self-monitor for signs and symptoms of COVID-19 (symptoms typically include fever, cough, and shortness of breath) and, contact us if he/she experiences symptoms of COVID-19 within 14 days after participating at our event.
I understand and will comply.

We are so excited to offer this event to the community! We hope to see each of you there! While this event is FREE to its participants, the cost per guest averages about $40. If you would like to make a donation of ANY amount to help, click the button below.

Strokes for a Cause

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