Atherton Leisure Centre Questionnaire

Newham Council is considering options for the future of Atherton Leisure Centre. Please complete this questionnaire to help us develop proposals for an improved leisure centre that fully meets the needs of residents and users. Your views will be taken into account by the Mayor and Cabinet when they decide the future of the centre after the consultation closes on 13 March 2012. Newham Council abides by the Market Research Society (MRS) code of conduct.  The results of this survey are confidential and will only be used for analytical purposes and you will not be asked to divulge any confidential data.  Any information you do provide will not be stored with any of your personal data.

SECTION A: LEISURE ACTIVITIES

Are you a Newham resident?

Yes

No

	In what capacity are you responding to the survey?  Are you a: PLEASE TICK ALL THAT APPLY.
	Leisure centre member		Partner organisation (please specify)
	Occasional leisure centre user		Member of a community group (please specify)
	Member of a local club (please specify)		Member of a voluntary organisation (please specify)
	Local business (please specify)		Other (please specify)

	Please specify:

	Please indicate how often you use each of the following leisure centres.
		Daily		At least once a week		Around once a fortnight		Around once a month		Rarely		Never
	Atherton Leisure Centre
	Balaam Leisure Centre
	East Ham Leisure Centre
	Newham Leisure Centre
	Other Leisure Centre (please specify)

	Please specify:

If you do not currently use Atherton Leisure Centre, have you used it in the past?

Yes

No

	If you do not currently use Atherton Leisure Centre, please tell us why. PLEASE TICK ALL THAT APPLY.
	Opening hours		No interest in leisure centre activities
	Lack of services on offer		Access problems to facilities
	Poor quality facilities		Lack of parking
	Too far to travel		Other (please specify)

	Please specify:

	What do you like about the current Atherton Leisure Centre?

	What do you not like about the current Atherton Leisure Centre?

	What services and facilities would you like to see in an improved leisure centre?

SECTION B: ABOUT YOU

Please complete your contact details below if you would like to be kept informed or would like to receive feedback on the results of the consultation.  Please note the results of this survey are confidential and will only be used for analytical purposes and you will not be asked to divulge any confidential data.  Any information you do provide will not be stored with any of your personal data you provide below.

Name:

Email:

Address:

Phone Number:

The next few questions are about yourself and completing them is optional.  Newham Council is committed to eliminating discrimination and promoting equal opportunities.  We want to deliver and improve our services and ensure that services are available to all members of our community and the data collected on this form will help us to achieve this.  The data will also be used to report on the needs of different groups of people.  The information that you provide on this form will remain confidential and will be used for monitoring purposes only.

	Are you:
	Male		Female		Prefer not to say

	Is your gender identity the same gender you were assigned at birth?
	Yes		No		Prefer not to say

	What age group are you in?
	Under 18		35-44		65+
	18-24		45-54		Prefer not to say
	25-34		55-64

	Do you consider yourself to be a disabled person?   The Disability Discrimination Act 1995 defines disability as "a physical or mental impairment, which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities".  This includes people with physical impairments, visual impairments, hearing impairments, deaf BSL users, people with learning difficulties including people with specific learning difficulties like dyslexia, people with mental health needs and people living with a health condition, e.g. HIV, multiple sclerosis, cancer.
	Yes		No		Prefer not to say

	It helps us to know whether we are reaching all disabled people.  Can you please select the relevant impairment (disability) group below?  You can tick more than one box, if appropriate.
	Physical impairment		Visual impairment		Other
	Hearing impairment		Deaf BSL user		Prefer not to say
	Learning difficulties		Blind
	Mobility impairment		A health condition e.g. HIV, multiple sclerosis or cancer

	Other, please specify

How would you describe you ethnic origin?  PLEASE SELECT ONE OPTION ONLY.

	White	British
		Irish
		Polish
		Lithuanian
		Romanian
		Other Eastern European (specify)
		Any other white background (specify)

Other, please specify

	Mixed	White and Black Caribbean
		White and Black African
		White and Asian
		Any other mixed background (specify)

Other, please specify

	Asian	British
		Indian
		Pakistani
		Bangladeshi
		Sri Lankan Tamil
		Any other Asian background (specify)

Other, please specify

	Black	British
		African
		Caribbean
		Nigerian
		Somalian
		Ghanaian
		Any other Black background (specify)

Other, please specify

	Chinese or Chinese British	British
		Chinese
		Other

Other, please specify

	Other ethnic origin	Irish Traveller
		Roma Gypsy / Traveller
		Other (specify)

Other, please specify

		Any other (specify)
		Prefer not to say

Other, please specify

	How would you describe your religion or beliefs?
	Buddhist		Paganism
	Christian		Atheist
	Hindu		Agnostic
	Jewish		None
	Muslim		Any other religion or belief
	Sikh		Prefer not to say

	Other, please specify

	How would you describe your sexual orientation?
	Lesbian		Heterosexual
	Gay man		Other
	Bisexual		Prefer not to say

	Other, please specify

Thank you for completing this survey.  Your feedback is very important and will help us develop proposals for an improved Atherton Leisure Centre. Full details of plans for the future of Atherton Leisure Centre will be available in the Newham Mag and by visiting www.newham.gov.uk/atherton