Andover Community Centre registration

• Physical activities – keep fit, zumba, pilates etc.
• Adult Education – ESOL, literacy, maths, creative writing etc.
• Social
• Routes to Employment CSCS courses, social care courses, employability support
• Advice and support – on debt, benefits, housing, family support
• IT – basic computer use, coding

• Yes
• No

• No
• Yes: under 5 years
• Yes: 5-19 years

• Female
• Male
• Non-binary
• Prefer not to say

Trans is an umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, that which they were assigned at birth.

• No
• Yes
• Prefer not to say

• Under 16
• 16-24
• 25-44
• 45-64
• 65+
• Prefer not to say

Do you have any physical or mental health conditions, impairments or illnesses lasting or expected to last for 12 months or more? 

• No
• Yes
• Don't know
• Prefer not to say

• Yes, a lot
• Yes, a little
• No
• Prefer not to say

• Vision (e.g. blindness or partial sight)
• Deaf / British Sign Language User
• Hearing (e.g. deafness or partial hearing)
• Physical (e.g. mobility or dexterity)
• Learning, understanding or concentrating
• Memory
• Mental health condition
• Non visible health condition/ impairment (i.e. cancer, HIV)
• Socially or behaviourally (e.g. associated with autism spectrum disorder, or attention deficit hyperactivity disorder)
• Prefer not to say

• Buddhist
• Christian
• Hindu
• Jewish
• Muslim
• No religion
• Rastafarian
• Sikh
• Other
• Prefer not to say

• Bisexual
• Heterosexual/Straight
• Gay
• Lesbian
• Prefer not to say

Please tick the appropriate box to indicate your ethnic background.

• White - British
• White - Irish
• White - Turkish Turkish Cypriot
• White - Greek/Greek Cypriot
• White - Kurdish
• White - Gypsy/Traveller
• White Prefer not to say
• Mixed - White and Black African
• Mixed - White and Black Caribbean
• Mixed - White and Asian
• Mixed Prefer not to say
• Asian or Asian British - Indian
• Asian or Asian British - Pakistani
• Asian or Asian British - Bangladeshi
• Asian or Asian British - Chinese
• Asian or Asian British - Prefer not to say
• Black or Black British - Caribbean
• Black or Black British - Somali
• Black or Black British - Eritrean
• Black or Black British - Nigerian
• Black or Black British - Ghanaian
• Black or Black British - Other African
• Black or Black British - Prefer not to say
• Arab
• Latin American
• Prefer not to say