Referral Form May – August 2023 Please enable JavaScript in your browser to complete this form.Participant SectionTo be filled out by workshop attendee. All session start week beginning 8th May.Title *Mr, Mrs, Miss, Ms etc.PronounsHe/HimShe/HerThey/ThemName *FirstLastEmail *Phone *Date of Birth *day/month/yearAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeWhich group would you like to try? *Monday 12pm - 2pm Embroidery (In Person) Nemo Arts StudioTuesday 12pm - 2pm Drama (In Person) Nemo Arts StudioWednesday 12pm - 2pm Visual Art (In Person) Castlemilk Community CentreWednesday 12pm - 2pm Guitar (In person and on Zoom) Nemo Arts StudioWednesday 2:30pm-4:30pm Choir (In Person) Nemo Arts StudioThursday 12pm - 2pm Guitar (In person and on Zoom) Nemo Arts StudioThursday 2:30 - 4:30 Drama (In person) Nemo Arts StudioFriday 2:30pm - 4:30pm Visual Art (In person and on Zoom) Nemo Arts StudioSaturday 12pm - 2pm Visual Art (In person and on Zoom) Nemo Arts StudioSupport NeedsPlease tell us if there is anything you think we should know to help you participate, for example leaving space at the table for wheelchair access, large print or being closer to the tutor to hear better. Referring Agency To be filled out by referrer, if you are self referring please provide emergency contact details.NameFirstLastPhoneEmailRole for instance O.T, CPN, CMHT, Social WorkerDoes the person have a care plan and does this activity contribute towards it?Please describe what outcomes are expected for the participant during their attendance at Nemo ArtsWould you prefer to attend workshops at our studio or online? *OnlineAt our studio (in-person)MessageSubmit