South Gloucestershire Arts & Libraries Project Creative Arts Courses & Creative Cafe Name DOB Postcode Landline* Mobile* Who we should Name: contact in an emergency a Telephone number: – family member, friend, professional Relationship: Please tell us sessions you would like to attend: Creative Arts Patchway Library, Tuesdays Staple Hill Library, Fridays Course 6.30pm 8.00pm 10.30am 12noon – – – Remapping Your Life Patchway Library, Tuesdays Staple Hill Library, Fridays Creative Café – welcoming 1.30pm 3.00pm 1.30pm 3.00pm – – people and those with memory loss How did you hear the project? Please tell us anything you feel might be useful for us to know about you and your participation in this project: Do you have any access needs that we should know about? Please turn over . . . About us and the way that we work The project team is: Scott Farlow & Matthew Hemson Lead Artists – Donna Baber, Project Manager
South Gloucestershire Arts & Libraries Project Creative Arts Courses & Creative Cafe Name DOB Postcode Landline* Mobile* Who we should contact in an emergency – a family member, friend, professional Name: Telephone number: Relationship: Please tell us sessions you would like to attend: Creative Arts Course – Remapping Your Life Patchway Library, Tuesdays 6.30pm – 8.00pm Staple Hill Library, Fridays 10.30am – 12noon Creative Café – welcoming people and those with memory loss Patchway Library, Tuesdays 1.30pm – 3.00pm Staple Hill Library, Fridays 1.30pm – 3.00pm How did you hear the project? Please tell us anything you feel might be useful for us to know about you and your participation in this project: Do you have any access needs that we should know about? Please turn over . . . About us and the way that we work The project team is: Scott Farlow & Matthew Hemson – Lead Artists Donna Baber, Project Manager
Referral-form-2016-v2.docx