Exit this survey 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. Question Title * 1. Name Question Title * 2. Address Question Title * 3. Email Address Question Title * 4. Phone Number Question Title * 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) Question Title * 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) Question Title * 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 Question Title * 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 £3-£5 for Children holiday Programmes Yes £3-£5 for Children holiday Programmes No £3 for Education sessions £3 for Education sessions Yes £3 for Education sessions No £4-£5 for Performances (music, theatre) £4-£5 for Performances (music, theatre) Yes £4-£5 for Performances (music, theatre) No Question Title * 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 Question Title * 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 Question Title * 11. About you: 11-18 19-25 26-40 41-55 56-75 76 + Male Male 11-18 Male 19-25 Male 26-40 Male 41-55 Male 56-75 Male 76 + Female Female 11-18 Female 19-25 Female 26-40 Female 41-55 Female 56-75 Female 76 + Question Title * 12. Are you or a member of your family unemployed? Yes No Question Title * 13. What is your ethnicity? Please state: Prefer not to answer: Question Title * 14. Do you consider yourself to have a disability? Yes No Question Title * 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 Question Title * 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) Question Title * 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 ChampionsPlease tell us which of the following activities you are interested in Yes No Group wide opportunities Group wide opportunities Yes Group wide opportunities No Service Improvement Groups Service Improvement Groups Yes Service Improvement Groups No Community Champion Community Champion Yes Community Champion No Resident Training Resident Training Yes Resident Training No Question Title * 18. Preferred method of communication (please include contact details) Phone Text Letter Email Facebook Twitter Done