Year 12 Visual Arts: Art History & Conceptual Framework Application Form

Student Details
I identify my gender as
Do you identify as Aboriginal and Torres Strait Islander?
What is your cultural background?
Please include any medical requirements, allergies or access needs that might affect your participation in the program. This information is for planning purposes only.
Dietary Requirements
How did you hear about this program? (Please include teacher's name if applicable)
Parent/Carer to complete
Name *
Phone *

Emergency Contact Details

Name *
Phone *

Photo Permission
I  do hereby grant permission to Campbelltown City Council c/- Campbelltown Arts Centre to use the image and likeness of my child as outlined below:

  • Recordings and images from this program may be edited and used to publicise and promote Campbelltown Arts Centre, or as part of reporting requirements for funding.
  • Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of participants (including Your Child) for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the Campbelltown City Council and Campbelltown Arts Centre website.
  • This permission applies to workshops, performances and other activities conducted by C-A-C. I acknowledge that if at any stage I no longer wish for My Child’s images to be used, I will notify the Arts Centre in writing via email to
Student Application Questions
Why would you like to join the Saturday intensive, for Year 12 Visual Arts students at Campbelltown Arts Centre? *
Is there anything you'd like us to cover in the course?
How would you like to use your creative arts skills in future? (e.g. career, study, projects you'd like to undertake) **

The personal information provided on this application form will be used and disclosed by Campbelltown Arts Centre for general administration and communication, or for any purpose required or permitted by law. This information will be held securely and disposed of when no longer needed.