Dorothy's Arts Club – Registration of Interest
Dorothy's Arts Club is a new programme run by Quench Arts (www.quench-arts.co.uk) for young people aged 12-25 who are LGBTQIA+ or are allies. The weekly sessions will focus on different art forms in a safe and inclusive space. The whole project has been developed with young people for young people.

As the age range is wide, there will be 2 groups - one for those aged 12-16 and one for 17-25 year olds. 

If you are aged 18+, you can complete this form yourself. If you are aged 12-17, this form is for parents/carers to complete alongside the young person who wants to take part.

If you have any questions, feel free to call us on 07716 362478 or email: info@quench-arts.co.uk.

Sessions will take place on Mondays in term time, 6-8pm. 

The project is run by Quench Arts and sessions will take place at the Afro Caribbean Millennium Centre, 339 Dudley Road, Winson Green B18 4HB.

If you are still interested in your taking part, please complete the questions below.
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Young Person's full name: *
Date of birth (this project is for young people aged 12-25): *
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Young person's pronouns (she/her; he/him; they/them, etc): *
Ethnicity (optional)  – we ask this question to help us understand any gaps in the types of people we are reaching:
If over 18, Young Person's email contact:
If over 18, Young Person's telephone number:
If under 18, full name of parent/ carer/ guardian:
If under 18, email address for parent/ carer/ guardian:
If under 18, telephone number for parent/ carer/ guardian:

Address & postcode (this should be where the young person is residing):

 *

Optional - If your child attends school, please let us know which school they go to (this helps with our reporting to Birmingham Music Education Hub, who are match funding our Youth Music grant):

Please tell us about any access or learning needs that we need to be aware of. We are asking this question so that we can make the sessions as inclusive as possible. (Some examples might be needing wheelchair access, a disabled parking space, large print information, etc.).

 *

Please tell us about any allergies (we will be using craft supplies and know some people have allergies to different things, such as glue, cleaning products etc):

 *

Please tell us about any dietary requirements (for instance gluten free, vegan etc as we provide refreshments for the sessions):

 *

Please tell us any medication currently being taken (in case of an emergency):

 *

In the case of an emergency, please provide a name and telephone number of someone we can contact

 *
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