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Green Man Lane Have Your Say
We are very keen to find out what services and activities you would like to see in and around Green Man Lane. We would be very grateful if you could complete this form and help us to provide these.
*
1.
Name
(Required.)
2.
Address
3.
Email Address
4.
Phone Number
5.
What services would you like to see available at your local Community Centre?
Youth activities
Adult literacy
Sports and fitness classes
Arts & Crafts classes
Mother & Toddler groups
Computer classes (IT)
Activities for older people
Female only activities
Performing Arts Activities
Welfare rights and debt advice
Male only activities
Family first aid
Work preparation activities
Other (please specify)
6.
Which things on the following list concern you about where you live?
Not enough for teenagers to do
Not enough for children to do
Lack of activities for older people
Not enough opportunity for community to get together
Lack of employment opportunities
Lack of access to health and fitness activities
Not enough opportunities to do training and improve or develop skills
Other (please specify)
7.
What time of the day would you prefer to access services at your local Community Centre / or Community Cafe?
Morning
Afternoon
Evening
Any time
8.
Some programmes at the New Community Café will come with a cost would you be willing to pay for the following activities?
Yes
No
£3-£5 for Children holiday Programmes
Yes
No
£3 for Education sessions
Yes
No
£4-£5 for Performances (music, theatre)
Yes
No
9.
What arts activities interest you the most?
Film
Screen printing
Video
Theatre
Photography
Play writing
Dance
Screen writing
Drama
Drawing and painting
Graphic design
Poetry
Music
10.
Open would like to engage with performers from a wide range of cultures, would you like to get involved or know of anyone who would like to be involved?
Yes
No
11.
About you:
11-18
19-25
26-40
41-55
56-75
76 +
Male
11-18
19-25
26-40
41-55
56-75
76 +
Female
11-18
19-25
26-40
41-55
56-75
76 +
12.
Are you or a member of your family unemployed?
Yes
No
13.
What is your ethnicity?
Please state:
Prefer not to answer:
14.
Do you consider yourself to have a disability?
Yes
No
15.
If yes what is the nature of your disability?
No Disability
Hearing impairment
Difficulty with everyday tasks
Serious permanent injury
Wheelchair use
Speaking problems
Learning difficulties
Mobility problems
Sight problems
Mental health problems
16.
We would like to know your current thoughts on the local community so we can work on either, improving the negatives and enhancing the positives.
Your thoughts on community
Local issues or priorities (what’s good/what’s not so good)
17.
We have a variety of ways for residents, across all of our regions, to get involved. These allow residents to have their say and help shape the services we provide to them – from local neighbourhood improvements to more strategic business decisions. These include:
•Group-wide opportunities (By getting involved at a Group-wide level, residents can help make decisions about how A2Dominion is run)
•Service improvement groups (groups of residents who work on improving our key services)
•Quality Assurance Programme (e.g. mystery shopping)
•Community Champions
Please tell us which of the following activities you are interested in
Yes
No
Group wide opportunities
Yes
No
Service Improvement Groups
Yes
No
Community Champion
Yes
No
Resident Training
Yes
No
18.
Preferred method of communication (please include contact details)
Phone
Text
Letter
Email
Facebook
Twitter