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Dad's F.C.
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1.
Question 1.
If you are eligible for support we will make contact with you to provide you with further information. Please state your name, contact number and email address below.
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Question 2.
What is your post code?
3.
Question 3.
Can you tick any of the following boxes? Please tick all that apply.
I am a lone parent
I am a parent under 25
I am a parent with a disability
My child has a disability
I have 3 or more children
I am a parent of ethnic minority
My youngest child is less than 1 year old
4.
Question 4.
What is your employment status?
I work full time
I work part time
I am unemployed and looking for work
I am unemployed and not looking for work
I cannot work due to health issues
If employed, please state your job title:
This is required
Input box for - If employed, please state your job title:
5.
Question 5.
What is your current household income per month after tax? Please include any benefits you or your partner receive.
6.
Question 6.
What age are you?
16 - 21
22 - 30
31 - 40
41 - 55
55 +
7.
Question 7.
What would you like to achieve for yourself in the next 6 months?
8.
Question 8.
Do you feel that there is anything stopping you from increasing your income at present? If yes, please share your thoughts.
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Question 9.
In your opinion, what is missing in your local area for Dads?
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Question 10.
Dads FC is a 6 week programme made up of one 2-hour session a week. Please state any days and times which would not be suitable for you.
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Question 11.
How did you hear about Dads F.C.?
Social media
Jobcentre
Health Visitor
Home Link Worker
Community Practitioner (Early Years)
Child's School
Kilmarnock Football Club
Other (please specify):
This is required
Input box for - Other (please specify):
12.
Question 12.
Do you have any access requirements you would like us to be aware of?