PEI Cerebral Palsy Association Provincial Survey We would like to connect with individuals and families living with cerebral palsy in Prince Edward Island. Question Title * 1. The person answering this survey is: A parent/caregiver of a child with cerebral palsy. A parent/caregiver of a dependent adult with cerebral palsy. An independent adult with cerebral palsy. A professional working with someone with cerebral palsy. Question Title * 2. What is your age or the age of the individual diagnosed with cerebral palsy? 0-6 7-12 13-18 19-30 31+ Choose not to answer. Question Title * 3. Which county do you live in on PEI? Kings County Queens County Prince County Choose not to answer. Other (please specify) Question Title * 4. Do you or the person with cerebral palsy use mobility devices? Yes No Other (please specify) Question Title * 5. Do you or the person with cerebral palsy access respite services? Yes No Question Title * 6. What support services/programs do you feel are lacking on Prince Edward Island? Question Title * 7. What services/programs would you like to see organized by the PEI CP Association? Question Title * 8. Do you plan to become a member of the PEI CP Association? The membership fee is $5 per person or $10 per family. Yes No Question Title * 9. To sign up to be contacted by the Association about becoming a member, please provide your email address: Next