Transforming your community
Ladybarn Community Hub
Ward of residence? e.g. Withington, Burnage, Chorlton
Age
Gender
Ethnicity
Have you ever been involved in community activity? (art, music, craft, gardening, cooking, exercise etc.)
If a friend asked you what you enjoy doing, what would you respond?
What kind of community activity would you like to attend/take part in?
What support would you need to get involved? (accessibility)
How do you currently cope with your mental wellbeing when you are struggling?
How do you feel community activities may benefit you?
What skills & experience do you have that you feel would benefit others?
What kind of learning opportunities in the community would you be interested in?
What kind of volunteering opportunities in the community would you be interested in?
Are there any culturally specific activities you would like to take part in?
Do you have any children that would benefit from activities at the Hub?
Yes
No
If you answered 'Yes' please provide the children's ages and what activities they would like to take part in.
Is there anything else you would like us to know?
How much of an impact has the current 'cost of living crisis' had on you/your family?
1 - Not at all
2
3
4
5
6
7
8
9
10 - Severely
How confident are you in accessing support to make positive life choices?
1 - Not at all
2
3
4
5
6
7
8
9
10 - Totally
Overall, how would you rate your current physical health?
1 - Poor
2
3
4
5
6
7
8
9
10 - Excellent
Overall, how would you rate your current mental health?
1 - Poor
2
3
4
5
6
7
8
9
10 - Excellent
Thank you for taking the time to complete this feedback form
Please provide your contact details if you are happy for us to contact you about future events at Ladybarn Community Hub
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Submit
Should be Empty: