Children’s Centre Satisfaction Survey
1. Do you have any children under the age of 5?
Please Select: Yes
No
2. What is your post code?
3. Are you male or female?
Please Select: Male
Female
4. Are you a lone parent?
Please Select: Yes
No
5. Do you have a disability?
Please Select: Yes
No
6. Do you have a disabled child under 5?
Please Select: Yes
No
7. Which age range are you in?
<-Please Select->
Under 19
20 - 29
30 - 39
40 or over
8. Please select which ethnicity applies to you:
<-Please Select->
White British
White Irish
White Other
Black British
Black Caribbean
Black African
Black Other
Chinese
Other
Indian
Pakistani
Bangladeshi
Asian Other
Mixed White/ Black Caribbean
Mixed White/ Black African
Mixed White/ Asian
Any Other Mixed
I do not wish to respond
9. Have you heard about Children’s Centres?
Please Select: Yes
No
10. How would you like to receive information about Children’s Centres?
Please tick all that apply to you:
Internet/email
Text
Post
Telephone
Poster/leafl et
Face to face
Audio CD
Visual DVD
Braille
Other
No opinion
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