#MadeAtHome Survey

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* 1. Which of the Activities did you take part in today?

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* 2. First Name

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* 3. Last Name

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* 4. Postcode

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* 5. Email Address

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* 6. May we email you about other arts opportunities?

Yes, tell me about opportunities in Corby and Wellingborough

Yes, tell me about opportunities in only

Yes, tell me about opportunities in Wellingborough only

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* 7. Telephone/Mobile Number

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* 8. Gender

Female

Male

Non Binary

Prefer Not to Say

Other

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* 9. Age

Under 16

16-24

25-34

35-44

45-54

55-64

65+

Prefer Not to Say

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* 10. Ethnicity

White British

Mixed/Multiple Ethnic Background

Black or Black British

Asian or Asian British

Prefer Not to Say

Other (please specify)

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* 11. Disability

Yes, day to day activities limited a lot.

Yes, day to day activities limited a little

Prefer Not to Say

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* 12. How often do you take part in Arts Activities (Outside of Education) a year?

Never

Once

Twice

Three Times or more

Regularly

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* 13. How many people from your household took part in this activity

Adults

Pre-School Children

Primary School Children

Secondary School Children

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* 14. Have you been involved in previous Made in Corby Activity? Please Briefly say which events.

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* 15. What did you like about the activity?

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* 16. Is there anything you would change?

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* 17. Would you like to be entered into our prize draw for a chance to win one of two £50 High Street Shopping Vouchers? (T&Cs can be found on our wedsite at www.madeincorby.co.uk/made-at-home )

Yes