February Half Term Art Breaks Booking Form

Art Breaks 2025

Please complete this form by 5pm on Monday 27th January 2025.

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.

There is a suggested donation of £10 per family per session.

We will aim to be in contact by Friday 7th February 2025 to offer a session.

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* 1. Have you been to Art Breaks before?

Yes

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* 2. Would you like to inform us of any changes to the Consent Form completed on previous visits? (only applicable if you have been before)

Yes

Additional information

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* 3. Participant Information

First Name

Surname

Date of Birth

Age

School attended (please indicate if home schooled)

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* 4. Disability (if diagnosed)

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

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* 6. 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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* 7. Sibling Information (who will be attending)

Name, Age and Date of Birth

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* 8. Sibling: Disability (if diagnosed)

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

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* 10. Parent /Carer Information

First Name

Surname

Home Address

Address 2

City / Town

Post Code

Email Address

Phone Number

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* 11. Dates and times available for Art Breaks at Project Art Works in Hastings.
Please indicate a first and second choice.

	First choice	Second choice
Tuesday 18th February - 10.30am - 12.00pm	Tuesday 18th February - 10.30am - 12.00pm First choice	Tuesday 18th February - 10.30am - 12.00pm Second choice
Tuesday 18th February - 1.30pm - 3.00pm	Tuesday 18th February - 1.30pm - 3.00pm First choice	Tuesday 18th February - 1.30pm - 3.00pm Second choice
Wednesday 19th February - 10.30am - 12.00pm	Wednesday 19th February - 10.30am - 12.00pm First choice	Wednesday 19th February - 10.30am - 12.00pm Second choice
Wednesday 19th February - 1.30pm - 3.00pm	Wednesday 19th February - 1.30pm - 3.00pm First choice	Wednesday 19th February - 1.30pm - 3.00pm Second choice
Thursday 20th February - 10.30am - 12.00pm	Thursday 20th February - 10.30am - 12.00pm First choice	Thursday 20th February - 10.30am - 12.00pm Second choice
Thursday 20th February - 1.30pm - 3.00pm	Thursday 20th February - 1.30pm - 3.00pm First choice	Thursday 20th February - 1.30pm - 3.00pm Second choice

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

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* 13. Would you like to keep in touch and receive our newsletter?

Yes

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* 1. Have you been to Art Breaks before?

Question Title

* 2. Would you like to inform us of any changes to the Consent Form completed on previous visits? (only applicable if you have been before)

Question Title

* 3. Participant Information

Question Title

* 4. Disability (if diagnosed)

Question Title

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

Question Title

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

Question Title

* 7. Sibling Information (who will be attending)

Question Title

* 8. Sibling: Disability (if diagnosed)

Question Title

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

Question Title

* 10. Parent /Carer Information

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* 11. Dates and times available for Art Breaks at Project Art Works in Hastings.Please indicate a first and second choice.

Question Title

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

Question Title

* 13. Would you like to keep in touch and receive our newsletter?

* 11. Dates and times available for Art Breaks at Project Art Works in Hastings.
Please indicate a first and second choice.