Referral Form Please enable JavaScript in your browser to complete this form.Participant SectionTo be filled out by workshop attendee TitleMr, Mrs, Miss, Ms etc.Name *FirstLastEmailPhoneDate of Birth *day/month/yearAddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeWhich group(s) would you like to try?Visual Art GroupVisual Art (Creative Castlemilk)Guitar GroupDrama Group UkuleleWorkshop times can be found at theatrenemo.org/whats-onDo you require:I would like to borrow a tablet computerArt SuppliesA Guitar (must be able to pick up from our studio)A UkuleleTheatre Nemo has been funded to supply art supplies and if required lend a tablet with internet data. Theatre Nemo staff are available to help you to use the tablet if needed. We are are also able to lend a guitar when neccesary.Referring Agency To be filled out by referrer, if you are self referring this can be left blankNameFirstLastPhoneEmailRole 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 Theatre NemoJust to make sure you aren't a robot! * = MessageSubmit