Recreation Special Needs Survey

Charlotte County Community Services is reviewing community interest in Recreation and Leisure programming for families with members who have Special Needs.  Please help us by completing this brief survey.  Thank you.

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* 1. Participant's gender?

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* 2. Participant's age?

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* 3. If in school, name of school participant attends:

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* 4. Where does participant live?

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* 5. Do you frequent any of the following parks?

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* 6. Participant disability:

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* 7. On a scale of 1-5 with 5 being the most limiting, how would you rate the disability limits participation?

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* 8. In your opinion, which of the following creates the greatest barrier to participating in recreation or sports activities in Charlotte County? (choose one)

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* 9. Check all leisure program areas of interest:

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* 10. Are you interested in inclusion or do you prefer programs exclusive to special needs peers?

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* 11. Please provide us with contact information if you would like to be contacted about future programs

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