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Name
   
 
 
 
Age
   
 
 
 
Gender
 
 
 
Occupation
 
Student
 
Working adult
 
Retiree
 
 
 
Monthly Income
 
 
 
How do you usually spend your free time?
   
 
 
 
What kind of facility centre would you want it in your community?
   
 
 
 
Do the elderlies in your household participate in community events? 
 
Yes
 
No
 
 
 
If no, why?
   
 
 
 
What kind of activities do you think the old and young can take part together?