Artful Wellness Referral

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Please fill out this form to refer someone in financial need for a tuition free workshop at the ARTfactory.

Email *

Referral Partner's Last Name *

Referral Partner's First Name *

Referral Partner's Phone Number *

Participant's Last Name *

Participant's First Name *

Guardian's Name (If participant is under 18) *

Participant's Age *

If a minor, what school does the participant go to? *

Participant's Home Zip Code *

Participant's or Guardian's (if participant is a minor) Email *

Participant's or Guardian's (if participant is a minor) Mobile Phone *

Workshop Title Participant wishes to attend. (You must fill out a separate form for each class.) *

Meditative Drumming Workshop 5/11 1-2pm

Zentangle 6/16 2-4pm

Return to Inner Peace 6/22 1-3:30pm

Family Theatre Games 7/14 2-4pm

Swing Dance 7/28 2-4pm

Family Tap 8/3 1-4pm

Intro to Speaking 8/17 1-3pm

Watercolor Loose and Expressive 8/25 2-5:30pm

Jewelry Making 9/1 2-4pm

Meditative Drumming Workshop 9/14 1-2pm

Swing Dance 9/22 2-4pm

Meditative Drumming Workshop 10/19 1-2pm

Intro to Speaking 10/27 2-4pm

Meditative Drumming Workshop 11/2 1-2 pm

Telling Your Story Through Art 11/10 2-5pm

Meditative Drumming Workshop 12/10 2-3pm

Watercolor Loose and Expressing 12/14 1-4:30pm

Neurographic Art 12/15 10:30am-2pm

Meditative Spirals 12/15 3-5pm

Please describe any special accommodations we need to take into account for this participant. (If none, please write N/A.) *

What organization did you refer the participant from? *

Why do you believe this participant will benefit from this referral? *

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