International Project of Distinction

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* 1. Please enter the name and location of the site you visited. If unknown, please type N/A.

Site Name

Site City

Site State/Province

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* 2. Site Location Type

Park

School

Housing Development

Recreation/Community Center

Other (please specify)

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* 3. Approximately how far away is your home from the site you are visiting today?

Half mile or less

Between half mile and 1 mile

Between 1 and 5 miles

More than 5 miles

Visiting from out of town

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* 4. How did you travel to the site today?

Walk

Bike

Drive

Public Transportation

Other

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* 5. Including you, how many of each age group were with you today? (Provide a count for all that apply):

	Number
Young Children (ages 5 and under)	Young Children (ages 5 and under) Number menu
Children (ages 6 to 12)	Children (ages 6 to 12) Number menu
Adolescents (ages 13 to 18)	Adolescents (ages 13 to 18) Number menu
Adults (ages 19 to 64)	Adults (ages 19 to 64) Number menu
Aging Adults (65+)	Aging Adults (65+) Number menu

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* 6. How often do you visit this outdoor playspace?

Daily

3-4 times/week

Weekly

Monthly

First time visiting or rarely

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* 7. How likely are you to keep visiting this outdoor playspace?

Likely

Somewhat likely

Neither likely nor unlikely

Somewhat unlikely

Unlikely

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* 8. How inclusive and accessible do you feel this playspace is?

Very inclusive – offers a wide variety of play opportunities for all children.

Somewhat inclusive – includes several play options that meet different needs.

Neutral – provides a few options, but some children may feel left out.

Not inclusive – offers limited or no opportunities for all children to participate.

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* 9. How important is inclusion and accessibility to you?

Very important

A consideration but not a top priority

Neutral, sort of important

Not at all important

International Project of Distinction

Question Title

* 1. Please enter the name and location of the site you visited. If unknown, please type N/A.

Question Title

* 2. Site Location Type

Question Title

* 3. Approximately how far away is your home from the site you are visiting today?

Question Title

* 4. How did you travel to the site today?

Question Title

* 5. Including you, how many of each age group were with you today? (Provide a count for all that apply):

Question Title

* 6. How often do you visit this outdoor playspace?

Question Title

* 7. How likely are you to keep visiting this outdoor playspace?

Question Title

* 8. How inclusive and accessible do you feel this playspace is?

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* 9. How important is inclusion and accessibility to you?

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* 10. Anything you’d like to share with us about your play experience?