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Imaginarium Theatre Feedback Form
An anonymous form which helps us to monitor, evaluate and improve.
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Which of the following describes how you think of yourself?
Woman
Man
Non Binary
Gender Non-Conforming
I prefer not to disclose this information
Not Known
Other:
Clear selection
How would you describe your sexual orientation?
Bisexual
Gay
Heterosexual
Lesbian
Pansexual
Queer
Prefer not to say
Other:
Clear selection
How would you describe your class status?
Your answer
Are you a full-time or part-time carer?
(This is defined as someone who looks after a family member, partner or friend, who needs help because of their illness, frailty or disability. The care being-given is unpaid.)
Your answer
How would you describe your ethnicity?
Asian - Bangladeshi
Asian - Chinese
Asian - Indian
Asian - Pakistani
Other Asian Background
Black - African
Black - Caribbean
Other Black Background
Latinx
Mixed: White and Asian
Mixed: White and Black African
Mixed: White and Black Caribbean
Other Mixed Background
White - British
White - Irish
White - Traveller
Other White Background
Prefer not to say
Other:
Clear selection
Do you consider yourself a neurodiverse person?
Yes
No
I Don't Know
Prefer Not To Say
Other:
Clear selection
Do you consider yourself to have a disability or long-term health condition?
(This includes you have a physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do daily activities.)
Yes
No
I Don't Know
Prefer Not To Say
Other:
Clear selection
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