Referral Form Our referral form is currently closed for this block. Our next block will start in January, Please use this form if you would like to start courses in the next block. Please enable JavaScript in your browser to complete this form.Participant SectionTo be filled out by workshop attendee. All session start week beginning 8th January.Title *Mr, Mrs, Miss, Ms etc.PronounsHe/HimShe/HerThey/ThemName *FirstLastEmailPhoneDate of Birth *day/month/yearAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeWhich group would you like to try? *Monday 12pm – 2pm EmbroideryTuesday 2:30 – 4:30 Physical TheatreTuesday 12pm – 2pm DramaWednesday 2:30pm-4:30pm ChoirWednesday 12pm – 2pm GuitarWednesday 12pm – 2pm Visual Art (Castlemilk Community Centre)Thursday 12pm – 2pm GuitarThursday 2:30pm – 4:30pm DramaFriday 12pm – 2pm Visual ArtFriday 2:30pm – 4:30pm Creative WritingSaturday 12pm – 2pm Visual ArtSupport 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 ArtsPhoneSubmit