* 1. What age is your child? (in years)

* 2. Were you aware that Children’s Specialized Hospital offers community recreation programs?

* 3. At which of the following Children's Specialized Hospital locations do you live closest to?

* 4. Has your child ever participated in a Children's Specialized Hospital Community Recreation Program? (i.e. Adaptive Aquatics, Martial Arts, Camp, Friday Night Fever)

* 5. How many times per month does your child currently participate in structured recreational & social activities outside of school and therapy?

* 6. What type of recreation-based groups and programs would you like to see CSH provide? (Check all that apply)

* 7. What time of year would you prefer for our recreation programs to be offered? (Check all that apply)

* 8. On which of the following days would you prefer our programs to be offered? (Check all that apply)

* 9. What time of day would you prefer our programs to be offered? (Check all that apply)

* 10. Please leave suggestions or feedback regarding community recreation programming at Children's Specialized Hospital.

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