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Register for Brain & Imagination Art Therapy Group

Questions marked with a * are required

Please complete the form below to register your child for Brain & Imagination Art Therapy, an 8-week Art Therapy program for neurodivergent youth aged 12-15 years old.

We will be in touch closer to the start date to confirm attendance, payment options, and other details before the program commences.

Which program date are you registering for?

Groups are held weekly on Thursday afternoons and run for 1.5 hours. The group is held on site at Brain & Mind Hub Sunshine Coast. We will email you one week before your first session to check whether you are still able to join us on that date.

4:00pm - 5:30pm Thursday, 3 October 2024 to 21 November 2024 (8 weeks)

We are unable to join that program. Please notify me when additional dates are available.

Parent/guardian details
We will only use this information to contact you about the Brain & Imagination Art Therapy Group Program at Brain & Mind Hub Sunshine Coast. There is an option to opt-in for information about other programs further down.

First name

Last name

Phone

Email address

Child's details

Child's first name

Child's last name

Child's birth date (DD/MM/YYYY)

Are you registering more than one child for this program date?
Please complete a separate registration form for each child you would like to enrol.

Yes

No

Does your child have any accessibility requirements?

They use a wheelchair

They have a physical disability or limitation

They are deaf or hearing impaired

They are blind or visully impaired

They have environmental sensitivities such as auditory sensitivities

There is something else that BaMH can assist with:

Something else:

Emergency contact, if different from parent/guardian:

First name

Last name

Phone

Email address

Relationship to child

How we treat your personal information:
We request your consent to store your personal information securely as part of providing mental health services. This information includes your name, contact details, medical history, and treatment records. It will be used exclusively to enhance your care and ensure the highest quality of service. Your information will be kept confidential and will only be shared with authorised personnel directly involved in your treatment or as required by law. By signing this form, you agree to the collection, storage, and use of your personal information as described.

FULL NAME

EMAIL

Please enter the 4 digit code sent to

Resend code / Change email

Please type your signature in the box

Neuroscience for better mental health

Keeping your personal information secure
We place the highest importance on protecting the privacy and personal information of people seeking support and treatment at Brain & Mind Hub Sunshine Coast, as well as the privacy of their support people. We have comprehensive measures in place to ensure the security of your personal information, and you can learn more by viewing our Privacy Policy at tbmh.org.au/privacy-policy.

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