Stay and Play Active Session Equality and Diversity Monitoring Form - 2022
PARENTS/CARERS

Stay and Play Active sessions have been funded by the Kings Park Moving Together programme - https://hackney.gov.uk/moving-together

To meet our funding obligations, we need to collect equalities data to share with the funders.  

The information provided will be kept confidential and will be used for monitoring purposes only.

If you have any questions about the form, please ask a member of staff.
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Initial *
Postcode *
Date form completed *
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DD
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YYYY
Gender *
Is the gender you identify with the same as your gender registered at birth? 
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Age *

What is your ethnicity?

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box

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Do you have a disability?    
 *

What is your sexual orientation?

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What is your religion or belief?

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Are you a carer for a family member?  
 *

Have you been pregnant in the last 2 years or are you on maternity leave? 

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