Creative Impact Enrollment Form
Creative Impact is Life Changes’ art therapy and holistic wellness program designed to support your recovery and reentry journey. Through guided art, journaling, mindfulness, and group workshops, participants explore creative ways to express themselves, build coping skills, and strengthen emotional resilience. You don’t need to be an artist to join — just open to trying something new.
Participant Information
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Gender
*
Male
Female
Non-Binary
Prefer not to say
Program Interest
What interests you about Creative Impact?
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Do you have any past experience with art, journaling, or mindfulness? (No experience needed!)
Are there specific skills or goals you hope to work on in this program?
*
Acknowledgement
By signing below, I agree to participate in Creative Impact and to respect the group guidelines of safety, respect, and confidentiality.
Signature
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Date
*
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Month
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Day
Year
Date
Submit
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