Laura Foundation | June 2010

The Laura Foundation Therapeutic Recreation Center

The Laura Foundation is establishing a therapeutic recreation center in Madison, NH. The purpose of this survey is to determine what type of assistance is needed for families caring for individuals with autism, epilepsy and other special needs. The recreational activities will provide opportunities to build new skills, develop independence, and make friends. Your feedback from this brief survey will help guide us in the future offerings of leisure and recreational activities at the center. If it is easier to respond to this survey via e-mail, our address is laurafoundation@gmail.com.

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1. Does your child currently participate in an adaptive sports or therapeutic recreation program?

Does your child currently participate in an adaptive sports or therapeutic recreation program? Yes

2. If you answered "yes" to question one, what activities are they currently participating in or have participated in?

If you answered "yes" to question one, what activities are they currently participating in or have participated in?

3. Does your current program accommodate your needs and schedule?

Does your current program accommodate your needs and schedule? Yes

N/A (Not Applicable)

4. If you would like your child to participate in an adaptive sports or therapeutic recreation program but have not enrolled him/her, please state why. (Check all that apply)

If you would like your child to participate in an adaptive sports or therapeutic recreation program but have not enrolled him/her, please state why. (Check all that apply) Cost of program

Need for sibling child care

Distance

Transportation

Other (please specify)

5. What time of the year would your child most likely participate in programs? (Check all that apply)

	During the School Year	During the Summer
Weekdays (After School)	*What time of the year would your child most likely participate in programs? (Check all that apply) Weekdays (After School) During the School Year	Weekdays (After School) During the Summer
Weekends	Weekends During the School Year	Weekends During the Summer

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6. What activities is your child interested in? (Check all that apply)

What activities is your child interested in? (Check all that apply) Arts and Crafts

Basketball

Trail Biking

Cross Country Skiing

Therapeutic Gardening

Music Therapy

Rock Climbing (on rock wall)

Yoga

Horseback Riding

Alpine skiing

Swimming

Other (please specify)

7. Would your child’s siblings be interested in attending the program with them?

Would your child’s siblings be interested in attending the program with them? Yes