Artis | Evaluation registration form

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* 1. Your Name

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* 2. Your email address

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* 3. School Name

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* 4. Year Group

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* 5. Class name

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* 6. Please confirm that you have used an online random number generator to select the six children you are tracking. If not, please click here to do so.

Yes

No

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* 7. Is the child male or female?

	Male	Female
Child 1	Child 1 Male	Child 1 Female
Child 2	Child 2 Male	Child 2 Female
Child 3	Child 3 Male	Child 3 Female
Child 4	Child 4 Male	Child 4 Female
Child 5	Child 5 Male	Child 5 Female
Child 6	Child 6 Male	Child 6 Female

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* 8. Is the child entitled to free school meals (FSM)?

	Yes	No
Child 1	Child 1 Yes	Child 1 No
Child 2	Child 2 Yes	Child 2 No
Child 3	Child 3 Yes	Child 3 No
Child 4	Child 4 Yes	Child 4 No
Child 5	Child 5 Yes	Child 5 No
Child 6	Child 6 Yes	Child 6 No

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* 9. Has the child had Artis sessions before?

	Yes	No
Child 1	Child 1 Yes	Child 1 No
Child 2	Child 2 Yes	Child 2 No
Child 3	Child 3 Yes	Child 3 No
Child 4	Child 4 Yes	Child 4 No
Child 5	Child 5 Yes	Child 5 No
Child 6	Child 6 Yes	Child 6 No