Art Breaks Booking Form

Summer 2017

Please complete this form by Sunday 23rd July.

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 by in contact by Friday 28th July 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 first, second and third choice if possible.

	First choice	Second choice	Third choice
9th August - 10.00 -12.00pm	9th August - 10.00 -12.00pm First choice	9th August - 10.00 -12.00pm Second choice	9th August - 10.00 -12.00pm Third choice
8th August - 10.00 - 12.00pm	8th August - 10.00 - 12.00pm First choice	8th August - 10.00 - 12.00pm Second choice	8th August - 10.00 - 12.00pm Third choice
9th August - 1.30 - 3.30pm	9th August - 1.30 - 3.30pm First choice	9th August - 1.30 - 3.30pm Second choice	9th August - 1.30 - 3.30pm Third choice
10th August - 10.00 - 12.00pm	10th August - 10.00 - 12.00pm First choice	10th August - 10.00 - 12.00pm Second choice	10th August - 10.00 - 12.00pm Third choice
10th August - 1.30 - 3.30pm	10th August - 1.30 - 3.30pm First choice	10th August - 1.30 - 3.30pm Second choice	10th August - 1.30 - 3.30pm Third choice
8th August - 1.30 - 3.30pm	8th August - 1.30 - 3.30pm First choice	8th August - 1.30 - 3.30pm Second choice	8th August - 1.30 - 3.30pm Third choice

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* 5. Dates and time available for Art Breaks at St Mary’s Special School, Bexhill-On-Sea.
Please indicate first, second and third choice if possible.

	First choice	Second choice	Third choice
15th August - 10.30 - 12.30pm	15th August - 10.30 - 12.30pm First choice	15th August - 10.30 - 12.30pm Second choice	15th August - 10.30 - 12.30pm Third choice
15th August - 1.30 - 3.30pm	15th August - 1.30 - 3.30pm First choice	15th August - 1.30 - 3.30pm Second choice	15th August - 1.30 - 3.30pm Third choice
16th August - 10.30 - 12.30pm	16th August - 10.30 - 12.30pm First choice	16th August - 10.30 - 12.30pm Second choice	16th August - 10.30 - 12.30pm Third choice
16th August - 1.30 - 3.30pm	16th August - 1.30 - 3.30pm First choice	16th August - 1.30 - 3.30pm Second choice	16th August - 1.30 - 3.30pm Third choice
17th August - 10.30 - 12.30pm	17th August - 10.30 - 12.30pm First choice	17th August - 10.30 - 12.30pm Second choice	17th August - 10.30 - 12.30pm Third choice
17th August - 1.30 - 3.30pm	17th August - 1.30 - 3.30pm First choice	17th August - 1.30 - 3.30pm Second choice	17th August - 1.30 - 3.30pm Third choice

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

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* 7. Please indicate if you would like to go onto a reserve list for last minute cancellations.

Yes

Art Breaks Booking Form

Summer 2017

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 first, second and third choice if possible.

Question Title

* 5. Dates and time available for Art Breaks at St Mary’s Special School, Bexhill-On-Sea.
Please indicate first, second and third choice if possible.

Question Title

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

Question Title

* 7. Please indicate if you would like to go onto a reserve list for last minute cancellations.

Question Title

* 8. Disability (if diagnosed)

Question Title

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

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

Question Title

* 11. 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 first, second and third choice if possible.

Question Title

* 5. Dates and time available for Art Breaks at St Mary’s Special School, Bexhill-On-Sea.Please indicate first, second and third choice if possible.

Question Title

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

Question Title

* 7. Please indicate if you would like to go onto a reserve list for last minute cancellations.

Question Title

* 8. Disability (if diagnosed)

Question Title

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

Question Title

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

Question Title

* 11. 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 first, second and third choice if possible.

* 5. Dates and time available for Art Breaks at St Mary’s Special School, Bexhill-On-Sea.
Please indicate first, second and third choice if possible.