Stuarts Point Art House - Community Input Question Title * 1. Gender Female Male Question Title * 2. Age 18 - 24 25 - 34 35 - 44 45 - 54 55- 64 Over 64 Question Title * 3. Where do you live? Stuarts Point / Grassy Head / Yarrahapinni Scotts Head Eungai Creek Eungai Rail Macksville Other (please specify) Question Title * 4. Are you interested in activities for children? Yes No N/A Question Title * 5. If yes, what ages are your children? 1 - 4 5 - 8 9 -12 13 - 15 16 - 18 Question Title * 6. If yes please indicate which activities your children would like to attend (please note: it will be possible to access these activities using the government’s Creative Kids / Active Kids voucher) Gymnastics Hip hop Ballet Cultural Dances Drama Art and Craft Percussion/ drumming Choir Do you have any other suggestions for children’s activities? Question Title * 7. Please indicate preferred days and times for your children to attend activities Day / Time Day /Time Day /Time Day /Time Question Title * 8. Are you interested in activities for yourself? If yes, please indicate which activities. Contemporary dance Indonesian dance Yoga Choir Drama Craft Art Percussion / Drumming Meditation Tai Chi Do you have any suggestions for other activities? Question Title * 9. Please indicate preferred days and times for you to attend activities Day / Time Day /Time Day /Time Day /Time Question Title * 10. Please provide contact detaIls if you are happy to be contacted Name Email Address Phone Number Done