APPLICATION

I am the parent or carer of a child with mild anxiety.

My child's age is:

My child is in:

My child can function in a group environment.

Does your child feel worried or anxious?

I or my child has accessibility needs

I and my child can attend all 8 sessions of Culture Dose for Kids at the Grafton Regional Gallery in Term 2, 2024 (dates will be confirmed by December 2023)

This is a research program that uses the arts to engage young people. Black Dog Institute will be conducting brief surveys and interviews with children and parents as part of our research.

We will need your contact details to let you know whether  your application is successful.  Please provide your email below

Please provide the child's parent / carer's first name

Please provide the child's first name

Please provide your best contact phone number (if we have any questions for you)