Adaptive Recreation Interest Survey
 

The City of Eugene Adaptive Recreation Program at Hilyard Community Center needs your help. We are in the process of planning our recreational programs for the year. Please take the time to give us your input and ideas on what you would like to see offered. No personal information will be shared with third parties and the responses will be kept confidential. Please complete the survey and hit "submit" at the bottom of the page.

If you would like to fill this out online, please go to www.surveymonkey.com/s/adaptiverecreationsurvey. If you need assistance in filling out this survey, you may contact Hilyard Community Center at 541-682-5311 or come by the center at 2580 Hilyard St., or ask your personal agent, family member or friend help you out. Thanks for helping us make our program better.

1. AGE

2. GENDER

3. Primary Disability

4. Zip Code

What activities would you like to see offered? Please check if you are interested or not interested.

5. Art

6. Bicycling/adaptive cycling

7. Community Outings/Day Trips

8. Computer and computer games

9. Cooking classes

10. Dances

11. Dance instruction like line dance, ballet, exercise

12. Exercise classes, aerobics, fitness, weight training

13. Family activities

14. Fishing

15. Gardening

16. Music

17. Outdoor adventure activities, rafting, skiing, challenge course

18. Parent training/Provider training

19. Social groups and gatherings

20. Social Skill Class

21. Sports skills such as basketball, volleyball, softball

22. Swimming

23. Theater/Drama

24. Walking for Exercise

25. Young Adult Group,ages 19-26

26. Other Activities, Please Describe

27. Please list any services, classes or programs you feel Adaptive Recreation should be providing that are not currently offered.

28. Do you participate in any of the following activities? Please check all that apply.

29. Do you receive services from Full Access?

30. Do you receive services from Mentor Oregon?

31. What are the best times for you to do receational classes or programs? Please check all that apply.

32. How much are you be able to spend on a recreation activity?

33. What are the reasons you don't attend Adaptive Recreation Programs? Check all that apply.

34. What skills are you most interested in working on through recreation?

35. Additional Comments

36. If you would like to recieve information about recreation activities and programs, please give us your name, email address and phone number.

Thank you very much for taking the time to complete this survey. We apprecitate you taking the time to help us build a better program. Your input is important. Thank You. city of Eugene, Adaptive Recreation Staff. If you need to mail in this survey, please send it to: Adaptive Recreation, 2580 Hilyard ST., Eugene, OR 97405. If you need assistance in filling out this survey, please call 541-682-6365.