Art Breaks Booking Form Spring 18

Spring 2018

Please complete this form by Thursday 1st February.

Project Art Works aims to provide the best possible environment for engagement. We use the following information to support each young persons creative journey. Please complete each section as fully as possible.

Please consider carefully your availability before booking. Spaces are limited we endeavour to provide at least one session for all our participants.

There is a suggested donation of £5 per family per session. Please contact us if the charge causes financial concerns

Will we be in contact by Monday 5th February to confirm your session.

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* 1. Parent /Carer Information

First Name

Surname

Home Address

Address 2

City / Town

Post Code

Email Address

Phone Number

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* 2. Participant Information

First Name

Surname

Date of Birth

Age

School attended (please indicate if home schooled)

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* 3. Sibling Information

Name, Age and Date of Birth

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* 4. Dates and times available for Art Breaks at Project Art Works studio, Hastings.
Please indicate a first and second choice.

	First choice	Second choice
Thursday 15th February - 1.30 - 3.30pm	Thursday 15th February - 1.30 - 3.30pm First choice	Thursday 15th February - 1.30 - 3.30pm Second choice
Wednesday 14th February - 10.00 - 12.00pm	Wednesday 14th February - 10.00 - 12.00pm First choice	Wednesday 14th February - 10.00 - 12.00pm Second choice
Thursday 15th February - 10.00 - 12.00pm	Thursday 15th February - 10.00 - 12.00pm First choice	Thursday 15th February - 10.00 - 12.00pm Second choice
Wednesday 14th February - 1.30 - 3.30pm	Wednesday 14th February - 1.30 - 3.30pm First choice	Wednesday 14th February - 1.30 - 3.30pm Second choice

Art Breaks Booking Form Spring 18

Spring 2018

Question Title

* 1. Parent /Carer Information

Question Title

* 2. Participant Information

Question Title

* 3. Sibling Information

Question Title

* 4. Dates and times available for Art Breaks at Project Art Works studio, Hastings.
Please indicate a first and second choice.

Question Title

* 5. If you have a particular restrictions around your availability please add a note below.

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* 6. Disability (if diagnosed)

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* 7. Please describe the difficulties the young person experiences (please complete as fully as possible)

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* 8. Can you tell us any other information that will help us to support the young person i.e. likes, dislikes, other?

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* 9. Siblings: can you provide us with some information about their interests, painting, drawing, making etc.

Question Title

* 1. Parent /Carer Information

Question Title

* 2. Participant Information

Question Title

* 3. Sibling Information

Question Title

* 4. Dates and times available for Art Breaks at Project Art Works studio, Hastings.Please indicate a first and second choice.

Question Title

* 5. If you have a particular restrictions around your availability please add a note below.

Question Title

* 6. Disability (if diagnosed)

Question Title

* 7. Please describe the difficulties the young person experiences (please complete as fully as possible)

Question Title

* 8. Can you tell us any other information that will help us to support the young person i.e. likes, dislikes, other?

Question Title

* 9. Siblings: can you provide us with some information about their interests, painting, drawing, making etc.

* 4. Dates and times available for Art Breaks at Project Art Works studio, Hastings.
Please indicate a first and second choice.