Join the Bolsover Citizens' Panel

About the Citizens' Panel

The Citizens' Panel is made up of local residents who would like to take part in surveys from Bolsover District Council. Surveys cover a range of topics affecting the District including questions on services provided by the Council. We usually run two surveys a year in May/June and November however the maximum number of surveys in any year would be four. Citizens' Panel members may also get the opportunity to participate in Focus Groups to discuss issues affecting the local community.

To join the panel you must live in the area administered by Bolsover District Council and be aged 16+ at the time of registration.

Please fully complete this form to join the Citizens' Panel.

(1) Preferred Survey Format

In which format would you prefer to receive your survey from us...?

Email (electronic survey)

Post (paper questionnaire)

	If you require questionnaires in any other format (i.e. large print) please indicate below:

(2) Your details

Using your personal data

Your personal information will be used to send you surveys in the format requested. We also ask for your phone number on this form for contact purposes in relation to the Citizens' Panel or any Focus Group opportunities. The use of this contact method would be by exception. Please provide this information if you are happy to be contacted in this way.

All of the information that you give will be held securely and will be treated as confidential. The information that you provide will be used only for the purpose of administering the Citizens' Panel and will not be shared with any other organisation. Any information you give in future Bolsover District Citizens' Panel questionnaires will be anonymous and will be processed only by Bolsover District Council.

If you decide to join the Citizen Panel, the Council will be processing your personal details on the basis of consent which you can withdraw at any time by contacting by emailing BDC@AskDerbyshire.gov.uk. For more information on how we use personal information please go to our privacy statement on our website www.bolsover.gov.uk.

Title (Mr, Mrs etc.)

First Name

Surname

Email address

Telephone number

Address (please ensure you include your house number, street name, town and postcode)

(3) Declaration

I have read and understand the sections on About the Citizens' Panel and Using your personal data.

I would like to join the Bolsover District Citizens' Panel.

Please ensure you have ticked the declaration, your details are correct and you click the 'submit' button to complete the form and join the Citizens' Panel.