1. Please tell us your age range:
2. How important is it to you that you attend a Youth Group with people in your own age range?
3. How important is it to you that you share doing an activity with people in your own age?
4. Please tell if you are:
5. Please tell us if you are a wheelchair or powerchair user?
6. Please tell us if you currently attend another Youth Club
7. Please tick as many things below that you are interested in:
8.
Please tell us if there's something else that you are interested in?
9. Please tick all of the life skills full day events you may also be interested in:
10.
Please tell us about other Life Skills opportunities you might be interested in?
11.
When are the best days and times for you to attend?
12. Would you be bringing someone with you and if so who?
13. Please tell us what your expectations are for help and assistance from an enabler or carer, where you are not independent. (For example, help with transfers, personal hygiene, suctioning, tracheostomy care, PEG feeding etc).
14. Where you are not independent, would you be prepared to come with an enabler/carer for your specific needs?
15. The venue has been selected for its accessibility and good facilities. Do you have any comments about the choice of venue?
16. Here is your space to provide more comments, information or suggestions.
17. Would you be interested in attending a Youth Club?
18. Please leave your contact details (name, email or mobile number) if you wish to be notified when this group is formally set up?