Please complete the online form below, or download it here as a .doc

Note: All information in this application form will be treated confidentially.

Bookings are confirmed once proof of payment is received together with completed application form. Balance of payment is due a week before commencement of course.

Terms and Conditions apply see below

Banking details:
Account Name: Art-Cafe
Bank: FNB Business Cheque Account
Account Number: 622 385 909 48
Branch: 201 510
Reference: Your Name & Course
 Please send completed application form & proof of payment to:
 Email :  
 Fax:  086 604 6678
 SMS :  083 326 6655

The following form is for you to make an booking request for Art Therapy course. We will respond to this booking by email. You will need to secure any booking subsequent to our confirmation, by making a deposit in our account.

Workshop Date:
Full name:
Date of Birth:
Medical Aid Name:
Medical Aid Number:
How did you hear about this course:
Educational Background/ Profession:
Have you attended any therapy before? Yes No
If yes, please describe briefly?
Why would you like to participate in this course?
What do you perceive as your strengths?
What do you perceive as your weaknesses?
Any additional information you would like to include:

Terms and Conditions

  • Bookings are only confirmed by means of a deposit (or payment) and completed application form.
  • The number of applicants per course is limited & acceptance is on a 'first come first serve' basis, provided a completed application form & deposit/payment has been received.
  • Course fees may be partially claimed back from medical aid after attendance of the course.
  • Deposits are non-refundable.
  • Course dates are subject to a min of 6 participants.
  • In the unlikely event of there not being enough people to fill a course, or a course being postponed, you will be notified timeously. New options for dates will be provided & your booking will be automatically transferred accordingly and valid for 12 months thereafter.
  • In the event that you are not able to attend a course that you have booked for, your booking may be postponed if notification is received up to 3 weeks prior to course commencement. Bookings will remain valid for 12 months.* Postponements later than 3 weeks will be subject to a 50% course cancellation fee.
  • Bookings postponed/cancelled later than 7 working days prior to course commencement will unfortunately have course fee forfeited.
  • A suitable replacement for a course will be accepted together with a completed application form within 6 months of your booking.

" It was a time to forget about the problems and the world around met. Sam is a brilliant facilitator. Even though I was nervous, it was a time for me to reflect and to enjoy how therapeutic art can be. It calmed the storm that reigned inside of me. The Mandala Art Therapy workshop is like having a picnic next to a quiet river. You are granted time to reach that point where you can become quiet and can experience the Universe. A very comprehensive and thorough intro into Art Therapy. Covered a lot of ground in 5 days and left with a priceless manuals and a warm glow. "