Client Details *

First Name

Last Name

DOB

MM

DD

YYYY

Phone

(###)

###

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What workshop are you interested in? *

Fishing

Mosaics

Social Art

Gel Blasting

Plant Series

Life Skills

Boxing/Fitness

Dungeons and Dragons

Other

Date I would first like to attend: *

MM

DD

YYYY

Phone *

(###)

###

####

Phone *

(###)

###

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Medical Information *

Privacy Statement A Better Tomorrow Australia is collecting this medical information in order to address the medical needs during the workshop. For example. Diagnosis, Medical Management, Triggers, Allergies, Dietary Preferences etc. Anything relevant that we may need to know. Known Medical Conditions?

Yes

No

I consent to A Better Tomorrow Australia to taking photos and/or videos of me and my art for marketing purposes.

Yes

No