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* 1. Gender

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* 2. Age

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* 3. Where do you live?

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* 4. Are you interested in activities for children?

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* 5. If yes, what ages are your children?

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* 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)

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* 7. Please indicate preferred days and times for your children to attend activities

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* 8. Are you interested in activities for yourself? If yes, please indicate which activities.

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* 9. Please indicate preferred days and times for you to attend activities

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* 10. Please provide contact detaIls if you are happy to be contacted

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