Request a Booking Form

Artist: cj fleury

Your Personal Art Journal

Required Fields show asterisk (*)

Requested Program: *

Your Information

Name: *
Email: *
Telephone:
Mobile Phone

School/Organization Information

Name: *
Telephone:
Address:
School Board or Organization:

Request Date and Time

Option 1
Date: (Enter date range/month/specific date): *
Time: (eg: 1-3pm)
Option 2
Date: (Enter date range/month/specific date):
Time: (eg: 1-3pm)
Option 3
Date: (Enter date range/month/specific date):
Time: (eg: 1-3pm)

Additional Details

Total number of students/participants
and grade levels:*
Additional Notes:
Requested Language of Program: *
Please direct my request to:*