To help us monitor our new Stroud and District Play and Free-Time Strategy and associated play projects, please fill in this short questionnaire.

About You

Gender
	Male		Female

Age
	0 - 5		12 - 15
	6 - 11		16 - 18

Do you consider yourself to have a disability?
	Yes		No

Home Neighbourhood (e.g., Cainscross, Rodborough, Stonehouse, etc)

Postcode

Play Development

1. Do you know where your nearest play area is ?
	Yes		No

1a. If yes, please state which one(s)

2. Do you play outside after school/during the holidays ?
	Yes		No

2a. If no, please comment possible reasons why:

3. If yes, approximately how often do you play outside?
	Once a week		More than 5 times a week
	2 - 5 times a week

4. Please list what type of activities do you play?

5. What type of play equipment or play area do you prefer to use?   (Please tick as many as you prefer)
	Playground		Skate park
	Multi use games area		Open grass area

5a. Other (please specify)

Please click the submit button to complete this survey. You will then automatically be redirected to the homepage.