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Adapted Art Club Intake Form

Participant Information

First & Last Name*

Preferred name (If Different)

Age

Grade (if applicable)

Parent/Guardian Information (for minors)

Name

Phone Number

Email

Participant Contact (for ages 18-26)

Phone Number

Email

Assistance & Support Needs: Please check all that apply and add details as needed.

Sensory accommodations

Communication support

Mobility assistance

Fine‑motor assistance during crafts

Behavioral or emotional support

Other (please describe):

Additional Notes for Instructors (Anything helpful for creating a safe, supportive, sensory friendly experience.)

Class Details: Small, sensory friendly classes (up to 8 participants) with guided crafts and all materials included.

‪(919) 283-2949

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