Art Therapy Workshop Registration Form Organised by Muslim Wellbeing Ōtautahi

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Art Therapy Workshop Registration Form Organised by Muslim Wellbeing Ōtautahi

These free workshops are for Muslim youth and their friends or supportive whānau. All materials will be provided. Please fill in the form below to register.

Please feel free to contact us if you have any question. Sudi@pw.maori.nz

Venue: Matariki room, Purapura whetu,166 Saint Asaph Street, Christchurch Central

When: Thursday 24th of July , 5pm to 6:30pm

Thursday 31st of July

Thursday 7th of August

Thursday 14th of August

Thursday 21st of August

Full name

Age *

Phone number

Email Address *

Will you be bringing someone with you? *

Yes

If yes, what is their name and age? *

Which best describes you? *

I am a Muslim youth

I am a friend of Muslim youth

Do you think you would like to attend all of the workshops?

Yes

Clear selection

Do you have any specific needs, allergies, or accessibility requirements we should know about?

Would you like to be added to our WhatsApp group for updates and reminders?

Yes

Email me please,

Other:

How have you been feeling lately?

(Tick as many as you like — there’s no right or wrong answer)

I’ve been feeling a bit low

I’ve been feeling a bit stressed

I find myself feeling low most of the time

I find myself feeling stressed most of the time

My mood affects my day-to-day life

I’m not sure how I feel

I am okay

Other:

Required

What do you hope this art therapy group can help you with?

(Tick any that feel right for you)

I want a safe space to express my feelings

I want to feel more calm or grounded

I want to understand my emotions better

I want to connect with others

I want to try something creative or new

I’m not sure yet, but I’m open to it

Other:

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms