About you

Amber Valley Borough Council is committed to ensuring our services are accessible and designed to meet the diverse needs of Amber Valley communities. By completing this form you are helping us make sure we are meeting this commitment. You do not have to give this information if you do not wish to.

However if you choose to complete this form your details will not be linked to any other forms you have submitted. Your information will be stored confidentially with our equalities team.

Tell us about you

Previous form details

What form or consultation have you completed, or intend to complete? *

Age

Gender

Gender reassignment

Sexual Orientation

Marriage and civil partnership

Disabilities

A disabled person is someone who has a physical or mental impairment which has a substantial and long term adverse effect on their ability to carry out normal day to day activities.

Ethnic group

Religion

Pregnancy and maternity

Please indicate if any of the following apply to you:

I am expecting a baby
I have had a baby in the last six months
I am currently on maternity leave
None of these
Prefer not to say

Need further help or information?

Contact the team directly on 01773 570222 or email enquiry@ambervalley.gov.uk