Art Therapy Form February 2025 | Community Action For Better Living

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Ar therapy

Art Therapy Registration Form

Name of Young Person: *

First

Last

Date of birth *

Pronouns *

She / Her
He / Him
They / Them
Other

Gender *

Male
Female
Non-binary
Prefer not to say

Parent / guardian name: *

First

Last

Parent / guardian email address: *

Parent / guardian phone number: *

benefit Please Residential

Residential address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

What High School does the young person attend? *

Does the young person identify as Aboriginal and/or Torres Strait Islander? *

Yes
No

What is the young person's cultural background? *

Have you previously received support from CABL (previously known as BCWS)? *

Yes
No

Please briefly explain how the young person could benefit from participating in an art therapy group: *

The services provided by CABL are proudly funded by:

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