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

  • The number of applicants per course is limited and acceptance is on a 'first come first serve' basis provided the required application form and relevant payment have been received.
  • All payments are non-refundable but may be transferable in some circumstances.
  • Art Therapy South Africa reserves the right to postpone the course if minimum numbers for registration are not met, with at least 2 date options provided.
  • Your booking will be valid for postponed dates.
  • Full monies paid in this instance will be reimbursed if all dates are not suitable.
  • A suitable replacement for a course will be accepted together with a completed application form.

" 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. "