Summer Art Breaks Booking Form Survey

1.Have you been to Art Breaks before?

Yes

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

3.Participant Information

First Name

Surname

Date of Birth

Age

School attended (please indicate if home schooled)

4.Disability (if diagnosed)

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

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

7.Sibling Information (who will be attending)

Name, Age and Date of Birth

8.Sibling: Disability (if diagnosed)

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

10.Parent /Carer Information

First Name

Surname

Home Address

Address 2

City / Town

Post Code

Email Address

Phone Number

11.Dates and times available for Week One of Art Breaks at Project Art Works in Hastings.
Please indicate a first choices.

First choice

Tuesday 4th August - 10.30am - 12.00pm

First choice

Tuesday 4th August - 1.30pm - 3.00pm

First choice

Wednesday 5th August - 10.30am - 12.00pm

First choice

Wednesday 5th August - 1.30pm - 3.00pm

First choice

Thursday 6th August - 10.30am - 12.00pm

First choice

Thursday 6th August - 1.30pm - 3.00pm

First choice

12.Dates and times available for Week Two of Art Breaks at Project Art Works in Hastings.
Please indicate a first choices.

First choice

Tuesday 11th August - 10.30am - 12.00pm

First choice

Tuesday 11th August - 1.30pm - 3.00pm

First choice

Wednesday 12th August - 10.30am - 12.00pm

First choice

Wednesday 12th August - 1.30pm - 3.00pm

First choice

Thursday 13th August - 10.30am - 12.00pm

First choice

Thursday 13th August - 1.30pm - 3.00pm

First choice

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

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

Yes

Current Progress,

0 of 14 answered

Summer Art Breaks Booking Form

Art Breaks 2026