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* 1. Are you a local resident?

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* 2. Do you know anything about Mackie Rd Neighbourhood House (Mackie Rd NH? Such as

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* 3. Have you ever visited Mackie Rd Neighbourhood House (If completing this form in the house, have you been here before)?

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* 4. If yes, when did you last visit the House and for what reason? If no, has anything prevented you from visiting?

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* 5. Would you be interested in participating in activities at Mackie Rd Neighbourhood House, now or in the future?

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* 6. What activities/groups would you be interested in, and what days/time suit you best?

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* 7. Are there any issues in your Neighbourhood that you are concerned about?

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* 8. Please describe these (If you do not have any concern, just write N/A)

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* 9. Please leave your personal details so that you can keep up to date with what's on offer at Mackie Rd Neighbourhood House. If you are not interested in receiving our program, please fill in N/A.

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* 10. Any other comments or suggestions for Mackie Rd Neighbourhood House?

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