Name of person completing questionnaire (optional) _____________

Name of young person with additional needs (optional) 

Age range of child or children: 7 – 10 years  --------   11 – 14 years  --------    15 – 18 years ----------

Would your child be interested in attending any of the following activities to be held at a venue in Leek? (please tick).  Please note that young people must be accompanied by a responsible adult or responsible older sibling for all activities and trips.


Disco    ----

Mobile zoo    ----

Craft evening    ----

Dance workshop    ----

School of Rock (Chuckles)    ----

Games night    ----

Sports night    ----

Visiting theatre    ----

Cinema evening at the Foxlowe    ----

Science workshop (Fizz pop)    ----

Kids kitchen    ----


Do you have any additional ideas for activity sessions?



Would your child be interested in attending occasional sessions in the school holidays?  Yes/No




Would your child be interested in attending any of the following trips? (please tick)

Cinema trip    ----

Bowling    ----

Dimensions    ----

Disney on ice theatre trip at Birmingham    ----

Other theatre trips    ----

Zoo    ----

Flip out (Trampolining Stone)    ----


Are there any other trips your child would enjoy if so please give examples: 


Would you be interested in coach or minibus travel to venues?  Yes/No

Would you be interested in getting more involved in the running of the Club?  Yes/No

Would mums be interested in social events i.e. Spa, coffee, meal out etc


Would brothers and sisters be interested in their own meetings and establishing a network of friendship and support? 


Would dads be interested in their own social evening? 


If you have any other thoughts, ideas or comments please feel free to share them.



Many thanks for completing this questionnaire.  Be You Crew relies on its members to tell us what trips and activities they feel would benefit their families.


You can post, email or bring a copy of this questionnaire to the next Be You Crew met up



Call us:

07904 034596 Claire

07467 193260  Angela

The Close, Leek Road, Longsdon, ST9 9QH


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