Adaptive & Inclusive Recreation Program Suggestions Survey

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* 1. What are the age(s) of the family members who would be enrolling in AR programs?

Pre-K (2 - 4 yrs)

Youth (5 - 12yrs)

Teen (13 - 17yrs)

Adult (18+ yrs)

Active Adult (55+ yrs)

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* 2. When are you most likely to attend a program? Check all that apply.

Weekday (Monday - Friday)

Weekend (Saturday - Sunday)

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* 3. What times are you most likely to attend a class? Check all that apply.

Morning: 9am - 11am

Midday: 11:30am - 1pm

Afternoon: 1:30pm - 3:30pm

Evening: 4pm - 8pm

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* 4. Which activity format are you most likely to attend? Check all that apply.

Consecutive, multi-week programs/classes

A one-time program/class

Drop-in programs

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* 5. Which acitivities would you be interested in participating in?

	Not Likely to Particpate	Neutral	Highly Likely to Participate
Arts & Crafts	Arts & Crafts Not Likely to Particpate	Arts & Crafts Neutral	Arts & Crafts Highly Likely to Participate
Cooking	Cooking Not Likely to Particpate	Cooking Neutral	Cooking Highly Likely to Participate
Dance	Dance Not Likely to Particpate	Dance Neutral	Dance Highly Likely to Participate
Fitness	Fitness Not Likely to Particpate	Fitness Neutral	Fitness Highly Likely to Participate
Games (card games, board games, puzzles)	Games (card games, board games, puzzles) Not Likely to Particpate	Games (card games, board games, puzzles) Neutral	Games (card games, board games, puzzles) Highly Likely to Participate
Music	Music Not Likely to Particpate	Music Neutral	Music Highly Likely to Participate
Outdoor Activities (walks, hikes, outdoor & nature exploration)	Outdoor Activities (walks, hikes, outdoor & nature exploration) Not Likely to Particpate	Outdoor Activities (walks, hikes, outdoor & nature exploration) Neutral	Outdoor Activities (walks, hikes, outdoor & nature exploration) Highly Likely to Participate
Social Outings	Social Outings Not Likely to Particpate	Social Outings Neutral	Social Outings Highly Likely to Participate
Yoga	Yoga Not Likely to Particpate	Yoga Neutral	Yoga Highly Likely to Participate
Instructional Sports	Instructional Sports Not Likely to Particpate	Instructional Sports Neutral	Instructional Sports Highly Likely to Participate
Competitive Sports	Competitive Sports Not Likely to Particpate	Competitive Sports Neutral	Competitive Sports Highly Likely to Participate
Gymnastics	Gymnastics Not Likely to Particpate	Gymnastics Neutral	Gymnastics Highly Likely to Participate
Summer Camps	Summer Camps Not Likely to Particpate	Summer Camps Neutral	Summer Camps Highly Likely to Participate
Sensory Exploration	Sensory Exploration Not Likely to Particpate	Sensory Exploration Neutral	Sensory Exploration Highly Likely to Participate

Other (please specify)

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* 6. What are your goals when enrolling in an adaptive recreaiton program? Please check all that apply.

To make friends

To try something new or learn a new skill

To find a hobby

To be more active

To be a part of your community

Other (please specify)

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* 7. When enrolling in an adaptive recreation program, which aspects are most important to you?

	Not Important	Somewhat Important	Very Important
Small Class Sizes	Small Class Sizes Not Important	Small Class Sizes Somewhat Important	Small Class Sizes Very Important
Multiple Instructors	Multiple Instructors Not Important	Multiple Instructors Somewhat Important	Multiple Instructors Very Important
Quiet Environment	Quiet Environment Not Important	Quiet Environment Somewhat Important	Quiet Environment Very Important
Adapted Equiptment/Spaces	Adapted Equiptment/Spaces Not Important	Adapted Equiptment/Spaces Somewhat Important	Adapted Equiptment/Spaces Very Important
Social Skill Support	Social Skill Support Not Important	Social Skill Support Somewhat Important	Social Skill Support Very Important
Behavior Management Support	Behavior Management Support Not Important	Behavior Management Support Somewhat Important	Behavior Management Support Very Important
Personal Care Support (toileting)	Personal Care Support (toileting) Not Important	Personal Care Support (toileting) Somewhat Important	Personal Care Support (toileting) Very Important
Varied Communication Techniques (communication visuals)	Varied Communication Techniques (communication visuals) Not Important	Varied Communication Techniques (communication visuals) Somewhat Important	Varied Communication Techniques (communication visuals) Very Important
Pre-Program Communication (social stories, instructor bios)	Pre-Program Communication (social stories, instructor bios) Not Important	Pre-Program Communication (social stories, instructor bios) Somewhat Important	Pre-Program Communication (social stories, instructor bios) Very Important
Shorter Activity Durations	Shorter Activity Durations Not Important	Shorter Activity Durations Somewhat Important	Shorter Activity Durations Very Important
Modified Acitivity Instruction (single step directions)	Modified Acitivity Instruction (single step directions) Not Important	Modified Acitivity Instruction (single step directions) Somewhat Important	Modified Acitivity Instruction (single step directions) Very Important
Transportation To & From the Program	Transportation To & From the Program Not Important	Transportation To & From the Program Somewhat Important	Transportation To & From the Program Very Important

Other (please specify)

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* 8. How did you find out FCPR's AIR Programs?

Family Member/Friend

Online: Social Media, Website, Email

Program Flyer

Recreater Brochure

Support/Advocacy Agency

Other (please specify)

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* 9. Do you have any other comments or suggestions?

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* 10. Would you like to be included in a mailing list about upcoming AIR offerings?

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address