Location
331 East 70th Street
New York, NY 10021

Dates
Tuesday, November 21st
Tuesday, November 28th
Tuesday, December 5th
Tuesday, December 12th
Tuesday, December 19th

Hours
3:00 - 4:30 p.m.

Fee
$150

Contact
Leah Gable
Administration Manager
212-218-0481
lgable@lenoxhill.org

Sparking Wellness and Creativity Through Art

A Program for Individuals with Memory Impairments

Lenox Hill Neighborhood House is excited to announce a new Art Therapy program for individuals with mild to moderate stage dementia. This five-session course will explore the use of art to spark creativity, expressive outlets and cognitive stimulation. The person-centered process will focus on each individual’s strengths and the development of their own creative style. No previous art experience required!

The program will take place for five consecutive Tuesdays from November 21st through December 19th from 3:00-4:30pm at 331 East 70th Street. Pre-registration required. Program Fee: $150.

Enroll using the form below; pay by calling Leah Gable at 212-218-0481.

Participant *
Participant
Home Phone
Home Phone
Mobile Phone *
Mobile Phone
Address *
Address
Date of Birth *
Date of Birth
Select One
Languages Spoken *
Check All That Apply
For Demographic Purposes Only
$
Emergency Contact *
Emergency Contact
Emergency Contact Address *
Emergency Contact Address
Emergency Contact Phone (Work) *
Emergency Contact Phone (Work)
Emergency Contact Phone (Home) *
Emergency Contact Phone (Home)
Emergency Contact Phone (Mobile) *
Emergency Contact Phone (Mobile)
i.e. spouse, friend, sibling, child
Billing Contact *
Billing Contact
Billing Contact Address *
Billing Contact Address
Billing Contact Phone *
Billing Contact Phone
i.e. partner, caregiver, legal guardian
Caregiver Name *
Caregiver Name
If none, write "NA."
If none, write "NA."
i.e. spouse, legal guardian. If none, write "NA."
Describer help the caregiver provides *
Check all that apply
Please specify below
Please list type of service and provider name below (i.e. home-delivered meals, senior center, home care)
Primary Physician *
Primary Physician
Primary Physician Address *
Primary Physician Address
Primary Physician Phone *
Primary Physician Phone
Does the participant have any of the following impairments *
Check all that apply
Please provide information about participants' personal history including work and education background, hobbies and interests and other important information.

To pay, call Leah Gable at 212-218-0481.