Art Therapy Adult Group Enrollment Form
Full Name
Date of Birth
Phone Number
Email Address
Home Address
Emergency Contact Name & Relationship
Emergency Contact Phone Number
Relevant Health Information (physical/mental health, allergies, etc.)
What are your goals or hopes for joining this art therapy group?
Previous Experience With Art Therapy (if any)
Availability (days/times suitable for you)
Is there anything else you would like us to know?