Are you interested in taking part in future Council consultations?   Complete this form to register your details and your interests, and we will notify you about relevant consultations throughout the year.   All information collected will be treated in confidence and used for consultation purposes only. Only persons aged 16 years old and over can register their details.

To inform us of a change in contact details you have previously registered, please email consultations@centralbedfordshire.gov.uk or call us on 0300 300 8301

Section A - Your contact details

* Indicates mandatory fields

1.	* Title
	--Click Here--MrMrsMissMsDrOther (please specify)

Please specify other

2.

* First name

3.

* Surname

4.

Email address

5.

Confirm email address

6.

* 1st line of address

7.

2nd line of address

8.

* Town

9.

* County

10.

* Postcode

11.

Day time telephone number

12.

Evening telephone number

Section B - Your topics and services

Consultation may take place on a number of different topics and services throughout the year.

13.	* Which topics and services would you like to be consulted about?   (Tick all that apply)
	All of the topics below
	Council tax & Council spending plans
	Benefits
	Children’s social care
	Fostering and adoption
	Youth services (e.g. youth centres and connexions)
	Education and schools (e.g. school transport)
	Special education needs (e.g. SEN transport)
	Early years education (e.g. nurseries and children’s centres)
	Adult social care (e.g. learning disabilities, physical disabilities, older people services, home care and occupational therapy)
	Council housing
	Crime and anti-social behaviour
	Trading standards
	Environmental health
	Licensing
	Street cleaning
	Refuse and recycling collection
	Waste and recycling (e.g. recycling centres, landfill and energy from waste)
	Parks and open spaces
	Countryside (e.g. country parks and rights of way)
	Leisure (e.g. sports, arts, libraries, theatres, archives, events and tourism)
	Public transport
	Traffic management
	Transport strategy
	Road safety
	Roads and pavements (e.g. potholes, repair and street lighting)
	Business and economic growth
	Planning (e.g. development control, building control, strategic planning, housing growth)
	Local democracy (e.g. councillors, elections, scrutiny)
	Corporate policy (e.g. council-wide strategies and policies)
	Communications (e.g. council communications including News Central and the website)
	Customer services (e.g. customer service standards and satisfaction)
	Minerals and waste
	Other

Other (please write in)

Section C - About you

This section is voluntary but we would encourage you to complete as many questions as you can.  The following information will help us when considering your opinions and to make sure that we're getting the views of all members of the community.

14.	Are you:
	--Click Here--FemaleMale

15.	What is your age?
	--Click Here--16-1920-2425-3435-4445-5960-6465-7475+

16.	Which one of these groups best describes you?
	--Click Here--Asian or Asian BritishBlack or Black BritishChineseMixedWhite BritishOther (please write in below)

Please specify other

17.	Do you consider yourself to be disabled?   Under the Disability Discrimination Act 1995 a person is considered to have a disability if he/she has a physical or mental impairment which has a sustained and long-term adverse effect on his/her ability to carry out normal day to day activities.
	--Click Here--YesNo

18.	If yes, please state which of the following best describes your disability (tick all that apply)
	Learning
	Mental
	Physical
	Sensory
	Other

Please specify other

19.	Which one of these best describes you?
	--Click Here--Bisexual Gay manHeterosexualLesbian/ gay womanOther

Please specify other

20.	Are you:
	--Click Here-- BuddhistChristianHinduJewishMuslimSikhNoneOther

Please specify other

21.	* All the data you supply on this form will be held and used in accordance with the Data Protection Act.  Your details will be kept securely by the Council and will only be shared with Council services undertaking consultations on the topics of your choice. However, sometimes one of our key partners may be undertaking a consultation on a subject relevant to your interests.  In this instance we may want to share your details with these partners (Police, Fire and Health Service).  To indicate whether you agree or disagree with sharing your details with these partners please tick one box below.
	I agree to my details being shared with the Police, Fire and Health service for consultation purposes.
	I do not agree to my details being shared with the Police, Fire and Health service for consultation purposes.

Thank you for your interest. Please click on the submit button below to send us your completed form.   We will notify you of relevant consultations throughout the year.

If you have any questions please e-mail the Communications Team on consultations@centralbedfordshire.gov.uk