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1 Abundant Cmmunity Initiative Blck Cnnectr Questinnaire Each participant will have their wn frm entry (unlike the printed sheet that allws fr multiple participants n 1 frm). Please use prper capitalizatin fr the names and addresses. This frm will underg changes in the next few days. This shuldn't interfere with yur entry prcess. If yu have suggestins fr additins t the check lists, include such suggestins in questin 8. Thanks. * Required First Name * This is a required questin Last Name * This is a required questin Street Address * City and Prvince nt required This is a required questin Pstal Cde * Usual frmat including the space Please use prper frmat. E.g. T5R 3J9 This is a required questin Address e.g. name@mailserver.cm Must be a valid address This is a required questin Birth Year Please enter a 4 digit year This is a required questin 1. What d yu value in a neighburhd? Please use cmmas t separate "Other" respnses.

2 Activities - Playgrund Activities - Sprts Teams Activities - Tennis Activities - Walking/Running/Biking Paths Amenities - Neighburhd Schl Amenities - Church Amenities - Schl Amenities - Shpping Amenities - Sprts Facilities Atmsphere - Quiet Atmsphere - Peaceful Atmsphere - Pride f Ownership Cmmunity f Caring Cmmunity f Caring - Bringing meals in times f need Cmmunity f Caring - Taking care f each thers pets Cmmunity f Caring - Watching each thers hmes Gegraphy - Accessibility Gegraphy - Alleys Gegraphy - Green Space Gegraphy - Large Lts Gegraphy - Off Leash Area Gegraphy - Prximity t Wrk Gegraphy - River Valley Gegraphy - Trees Peple - Cnnectedness Peple - Friendly Peple - Friends Peple - Neighburly Peple - Supprtive Security Lw Crime Rate Security Safety This is a required questin 2. What d yu think the ideal LH neighburhd wuld lk like? What imprvements wuld yu like t see in this neightburhd. Please use cmmas t separate "Other" respnses. This IS the ideal neighburhd Events - Keep Beer Garden

3 Events - Mre Blck Parties Events - Mre Scial Events Infrastructure - Better Snw Remval Infrastructure - Diversity f Husing Infrastructure - Fixed Sccer Field Infrastructure - Imprved Pt Hle Repair Infrastructure - Mre tennis curts Infrastructure - Renvated Hall Infrastructure - Upgraded Rads Prgrams - Babysitter Curse Prgrams - Babysitter Meet & Greet Prgrams - Keep Playgrup Prgrams - Mre Sprts Prgrams Prgrams - Mre Structured Prgrams Prgrams - Mre Tennis Lessns Prgrams - Tennis Cach Security/Safety - Cyte Den Management Security/Safety - Drug Deal Eliminatin Security/Safety - Ft Bridge Camera Security/Safety - Ft Bridge Imprved Lighting This is a required questin 3. What activities r grups that yu participate in, r want t participate in, wuld yu jin in with neighburs? Select all that apply. Please use cmmas t separate "Other" respnses. Creative - Canning/preserving Creative - Cking Creative - Dance Creative - Interir decrating Creative - Jewelry- making Creative - Knitting Creative - Painting Creative - Playing an Instrument Creative - Sculpting Creative - Singing/Chir Creative - Writing Outdrs - Back Cuntry Outdrs - Bird watching

4 Outdrs - Bating Outdrs - Camping Outdrs - Dg walking Outdrs - Fishing Outdrs - Gardening Outdrs - Gecaching Outdrs - Hunting Outdrs - Walking Outdrs - - Hiking Scial - Beer/ wine club Scial - Blck parties Scial - Blgging Scial - Bnfires Scial - Bk Club Scial - Bwling Scial - Bridge Scial - Dinner club (meal exchange) Scial - Dinner parties Scial - Discussin grups - philsphy & religin Scial - Game nights Scial - Genealgy Scial - Outdr mvie nights Scial - Pker Scial - Scrabble Scial - Visiting senirs Scial - Yak 'n' Snack Sprts - Caching Sprts - Crss- cuntry skiing Sprts - Cycling - Muntain biking Sprts - Cycling - Rad riding Sprts - Fitness Sprts - Glf Sprts - Hckey Sprts - Ice skating Sprts - Running Sprts - Skatebarding Sprts - Skiing Sprts - Swimming Sprts - Tennis Sprts - Yga

5 Travel - Arctic Travel - Camping Travel - Eurpe Travel - Eurpe Travel - Hme Exchanges Travel - Missin trips Travel - Nrth America Travel - Sabbatical Planning Travel - Suth America Travel - Suth East Asia This is a required questin 4. D yu have interests r passins that yu wuld value discussing r jining in with neighburs? Culd include thse frm questin 3 r smething else. This is a required questin 5. What tpics r activities are yu familiar enugh with t perhaps rganize, lead in, r teach t, a grup f neighburs? Select all that apply. Please use cmmas t separate "Other" respnses. Creative - Canning/preserving Creative - Cking Creative - Dance Creative - Interir decrating Creative - Jewelry- making Creative - Knitting Creative - Painting Creative - Playing an Instrument Creative - Sculpting Creative - Singing/Chir Creative - Writing Outdrs - Back Cuntry Outdrs - Bird watching Outdrs - Bating Outdrs - Camping Outdrs - Dg walking Outdrs - Fishing Outdrs - Gardening

6 Outdrs - Gecaching Outdrs - Hunting Outdrs - Walking Outdrs - - Hiking Scial - Beer/ wine club Scial - Blck parties Scial - Blgging Scial - Bnfires Scial - Bk Club Scial - Bwling Scial - Bridge Scial - Dinner club (meal exchange) Scial - Dinner parties Scial - Discussin grups - philsphy & religin Scial - Game nights Scial - Genealgy Scial - Outdr mvie nights Scial - Pker Scial - Scrabble Scial - Visiting senirs Scial - Yak 'n' Snack Sprts - Caching Sprts - Crss- cuntry skiing Sprts - Cycling - Muntain biking Sprts - Cycling - Rad riding Sprts - Fitness Sprts - Glf Sprts - Hckey Sprts - Ice skating Sprts - Running Sprts - Skatebarding Sprts - Skiing Sprts - Swimming Sprts - Tennis Sprts - Yga Travel - Arctic Travel - Camping Travel - Eurpe Travel - Eurpe Travel - Hme Exchanges

7 Travel - Missin trips Travel - Nrth America Travel - Sabbatical Planning Travel - Suth America Travel - Suth East Asia This is a required questin 6. What skills, gifts r abilities d yu have that yu wuld be cmfrtable using t help neighburs and/r the neighburhd? This is a required questin 7. Are there sme life experiences that yu wuld cnsider sharing fr the benefit f neighburs? This is a required questin 8. Any additinal infrmatin, ideas, thughts, cmments etc. This is a required questin Name f Blck Cnnectr * If the Blck Cnnectr is nt the ne entering this infrmatin r hanging n t the entry sheet then please indicate s. This is a required questin

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