Artist-Therapist Registry Survey

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* 2. In what ways do you envision being part of the Wellness Weavers network?

display in an art show

offer a presentation

conduct a training playshop-workshop

have wares for sale at the Farmers' Market

have wares for sale via the Wellness Weavers online store

be involved in a play

participate in an artist's retreat

participate in a group retreat for artists

Other (please specify)

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* 3. List the various ways you might be available to work with others.

private lessons

group workshop

retreat experience

demonstration at a festival

series of classes such as once a week for ___ weeks

roundtable dinner with an artisan

I have a caterers license

Other and/or additional details

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* 4. Indicate your level of expertise and experience in the following groups

	Certified	Educated & major experiences	Minor experiences	Not comfortable
Adults	Adults Certified	Adults Educated & major experiences	Adults Minor experiences	Adults Not comfortable
Families of all ages	Families of all ages Certified	Families of all ages Educated & major experiences	Families of all ages Minor experiences	Families of all ages Not comfortable
Preschoolers	Preschoolers Certified	Preschoolers Educated & major experiences	Preschoolers Minor experiences	Preschoolers Not comfortable
Grade schoolers	Grade schoolers Certified	Grade schoolers Educated & major experiences	Grade schoolers Minor experiences	Grade schoolers Not comfortable
Middle schoolers	Middle schoolers Certified	Middle schoolers Educated & major experiences	Middle schoolers Minor experiences	Middle schoolers Not comfortable
High schoolers	High schoolers Certified	High schoolers Educated & major experiences	High schoolers Minor experiences	High schoolers Not comfortable
Children with disabilities or other special needs	Children with disabilities or other special needs Certified	Children with disabilities or other special needs Educated & major experiences	Children with disabilities or other special needs Minor experiences	Children with disabilities or other special needs Not comfortable
Adults with developmental and physical disabilities	Adults with developmental and physical disabilities Certified	Adults with developmental and physical disabilities Educated & major experiences	Adults with developmental and physical disabilities Minor experiences	Adults with developmental and physical disabilities Not comfortable
Individuals with mental, emotional, or behavioral disabilities	Individuals with mental, emotional, or behavioral disabilities Certified	Individuals with mental, emotional, or behavioral disabilities Educated & major experiences	Individuals with mental, emotional, or behavioral disabilities Minor experiences	Individuals with mental, emotional, or behavioral disabilities Not comfortable
Independent Living Geriatrics	Independent Living Geriatrics Certified	Independent Living Geriatrics Educated & major experiences	Independent Living Geriatrics Minor experiences	Independent Living Geriatrics Not comfortable
Assisted Living Geriatrics	Assisted Living Geriatrics Certified	Assisted Living Geriatrics Educated & major experiences	Assisted Living Geriatrics Minor experiences	Assisted Living Geriatrics Not comfortable
Geriatrics with Mental, emotional, or behavioral dysfunction	Geriatrics with Mental, emotional, or behavioral dysfunction Certified	Geriatrics with Mental, emotional, or behavioral dysfunction Educated & major experiences	Geriatrics with Mental, emotional, or behavioral dysfunction Minor experiences	Geriatrics with Mental, emotional, or behavioral dysfunction Not comfortable
Individuals that are incarcerated	Individuals that are incarcerated Certified	Individuals that are incarcerated Educated & major experiences	Individuals that are incarcerated Minor experiences	Individuals that are incarcerated Not comfortable
War veterans or soldiers	War veterans or soldiers Certified	War veterans or soldiers Educated & major experiences	War veterans or soldiers Minor experiences	War veterans or soldiers Not comfortable

Specific certifications, etc:

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* 5. What facility assets are needed in considering the optimal facility to book for your event?

a workshop area

natural lighting

open air

access to a sink

conference work tables

small round group tables

theatre seating

a large projection screen

a projector

microphone

ability to darken the room

access to wireless high speed Internet

cooking facilities

refrigeration

resilient wood floor

carpeted floor

mirrors

an elevator

Specify size of group and size of room

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* 6. What is included in your fee structure?

my time

my travel

my food

my lodging

per diem fees

supplies

Other (please specify)

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* 7. What additional information might you need to provide us with to help us arrive at an affordable and fair fee to book and offer your services?

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* 8. Are you ready to discuss scheduling an event for you to lead?

Yes

Not quite

What dates are you interested in?

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* 9. Enter your contact information.

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number:

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* 10. Please supply website links (preferable) that demonstrate your work and credentials. Otherwise, supply reference contact information for three people, unrelated to you, who are familiar with your work.

Artist-Therapist Registry

1. Artisan Registry

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* 1. Which branch of the arts do you work with?

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* 2. In what ways do you envision being part of the Wellness Weavers network?

Question Title

* 3. List the various ways you might be available to work with others.

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* 4. Indicate your level of expertise and experience in the following groups

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* 5. What facility assets are needed in considering the optimal facility to book for your event?

Question Title

* 6. What is included in your fee structure?

Question Title

* 7. What additional information might you need to provide us with to help us arrive at an affordable and fair fee to book and offer your services?

Question Title

* 8. Are you ready to discuss scheduling an event for you to lead?

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* 9. Enter your contact information.

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* 10. Please supply website links (preferable) that demonstrate your work and credentials. Otherwise, supply reference contact information for three people, unrelated to you, who are familiar with your work.