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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? *
Required
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) *
Required
Please tick all boxes that apply to the services offered by your care home *
Required
Finally, what are your expectations about the impact cARTrefu might have within your care home? *
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