Join our Community Programme

If you, or someone you know is interested in joining our Community Programme, please complete the form below and we will be in touch shortly.

If you have any other questions, please get in touch via community@pallant.org.uk.

Name
First Last
Home address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Home telephone number
Home email
Daytime address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Daytime telephone number
Daytime email
Emergency Contact
Name
First Last
Relationship to you
Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Telephone number
Email
Other key contacts (e.g. social worker, key worker)
Medical information
Doctor's name
First Last
Doctor's address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Health needs (medication, diet, etc)
Support needs
About you
Transport needs
What days are you available to join workshops or studio sessions?
What are your interests in art?
What do you hope to get from joining the workshops or sessions?
How did you find out about the Community Programme?
Any other information or questions?
We sometimes take photos and film different sessions and events. Are you happy for us to use images of you taking part in these activities for promotion, press and in exhibitions
Please tick how you would like us to contact you
- Text message
- Email
- Phone call
- Post

Emergency Contact