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cARTrefu 3 application form
Thank you for your interest in phase 3 of cARTrefu, Age Cymru’s arts in care homes project.  Please fill in this form to register your care home for care home staff coaching workshops and/or activity plans.
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Name of care home *
Address of care home *
Postcode of Care Home *
Name of applicant *
Do you have the authority and responsibility to make decisions regarding staff attending cARTrefu workshops or activity plans taking place at your care home? *
If you answered ‘NO’ to the question above, is the Home Manager aware of you application? *
Care home manager name *
Please provide a contact email address for the care home manager *
Please provide a contact telephone number for the care home manager *
What part of cARTrefu 3 are you interested in being part of? *
How many staff members would be able to attend the sessions if applicable?
Clear selection
How many staff members would be involved in the development of the activity plans, if applicable?
Clear selection
Have you received a cARTrefu residency before? (This will not affect your application) *
Have you attended cARTrefu workshops before? (This will not affect your application) *
Are you interested in hosting a cARTrefu coaching session at your care home?
Clear selection
Is your care home (please tick all that apply) *
Please tick all boxes that apply to the services offered by your care home *
Finally, what are your expectations about the impact cARTrefu might have within your care home? *
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