Adaptive Sports Survey 2018

Adaptive Sports Survey

Athletes with Disabilities Network Northeast Chapter is a non-profit which promote a better quality of life for veterans and people with physical disabilities by creating awareness and opportunities to get involved with adaptive athletic, recreational, and educational activities. Our service is New Jersey, Philadelphia and surrounding counties. We would like to know what adaptive sports, clinics and events you would like in the region. Your input is very important for us to be able to understand the needs of the community and assist in providing these opportunities to you.

Question Title

* 1. What are the days and times that you have the most availability? (Check three)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Question Title

* 2. What are the best times for you to attend kayaking sessions? (you do not have to attend the whole time frame)

Mornings 8am-12pm

Afternoons 12pm-4pm

Evenings 4pm-7pm

Question Title

* 3. What is your level of disability?

Visually Impaired

down's syndrome

Above Knee Amputee

Below Knee Amputee

Hemipelvectomy

Upper Extremity

TBI

Cerebral Palsy

Spinal Cord Injury

Left or Right side hemiplegia

Stroke

Cognitive

Other (please specify)

Question Title

* 4. Would you like to be notified when sports equipment grants and others are available?

Yes ( please provide us with your email at the end of the survey)

Question Title

* 5. Are there any activities that you have already participated in like, tennis or climbing that you would like to have more opportunities to do again?

Question Title

* 6. If these recreational activities were available would you attend? Please check all that apply.

Standup Paddle board (also available for wheelchair) ?

Kayaking Recreational

Kayaking Racing- Sprint

Rowing

Soccer ( must be able to use forearm crutches)

USTA Tennis ( Cognitive, Wheelchair Tennis, Stand-up amputee league)

Power Wheelchair Tennis

Adaptive Tennis

Regular USTA League Tennis play

Running (lower Extremity Amputee, Racing Chair, Cognitive)

Cycling singe and Tandem (Visually Impaired, Cognitive, Spinal Cord, Amputee)

Swimming ( Visually Impaired, Cognitive, Spinal Cord, Amputee)

Wheelchair basketball?

Adaptive climbing?

Sit Volleyball?

White water kayaking?

Kayak Polo?

Wheelchair Softball?

Sprint Triathlon

Boccia Ball

Archery

Adaptive Fitness

Check this box if you would attend these events on a weekly basis to play or train if offered?

Check this box if you would attend area competitions?

Other (please specify)

Question Title

* 7. What county do you live in?

Camden, NJ

Burlington, NJ

Atlantic, NJ

Mercer, NJ

Ocean, NJ

Monmouth, NJ

Essex, NJ

Union County, NJ

Philadelphia, PA

Delaware, PA

Bucks, PA

Montgomery, PA

Chester, PA

Leigh High County, PA

Other County

Question Title

* 8. What age group best fits?

3-8

9-12

13-19

20-30

31-40

40-50

50-60

60+

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* 9. Do you attend College or University?

Yes

If yes where do you attend

Question Title

* 10. Thank you for taking the time to complete the survey. If you would like to be on our email list and receive upcoming events please provide us with your email below in question 10.
Optional Contact information. If you wish to not provide your contact information leave this section blank.
Brandon Holiday
Executive Director
Athletes with Disabilities Network North East Chapter
Bholiday@adnnec.org
267-242-4590
www.adnnec.org

Name

Veteran, service member, first responder, EMS, Police Officer or Paramedic? Yes or No

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

County

Email Address

Phone Number