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* 1. Gender

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* 2. What is your ethnic background?

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* 3. Do you consider yourself to have a disability?

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* 4. As a young person, which is more important to you?

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* 5. Which of the following activities are you interested intaking part in?

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* 6. Please rate the following statements according to how important they are to you.

  Unimportant Not Really Important Neither Important or Unimportant Important Very Important
Provision of opportunities for children and young people to support their physical and mental health
Provision of support for children and young people to achieve and remain in education and training
Encouraging children and young people to male positive choices preventing them from engaging in risk taking behaviours
Culmore Youth Club should provide children and young people with opportunities to explore environmental and climate issues
Culmore Youth Club allows children and young people to have a say on decisions and services that effect them.
Culmore Youth Club ensures that children and young people have access to a wide range of activities and opportunities.
Culmore Youth Club provides children and young people with opportunities to meet and engage with people from different backgrounds

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* 7. From the list below, please select what matters most to you about taking part in Culmore Youth Club.

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* 8. What activities/programmes could Culmore Youth Club provide that would be most helpful to you?

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* 9. Day of the week most suitable

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* 10. What time of day is most suitable?

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