Therapeutic Recreation Survey Question Title * 1. Age of Participant OK Question Title * 2. General nature of participants disability (please check all that apply) Cognitive / Developmental Physical Auditory Emotional / Mental Health Learning Disability Sensory Behavioral Social Speech / Language Autism Spectrum disorder OK Question Title * 3. What type of support would be the most beneficial social support: redirection, encouragement to interact with peers and to participate, understanding social interaction and assisting in conflict resolution physical support: Participant requires assistance with adaptive devices, navigating the environment, and/or mobility assistance. May need assistance with fine and/or gross motor skills group support: Participant functions independently, can follow directions, stays on tasks and is comfortable in a large social group. 1:1 support: Participant will need constant one on one assistance and has significant physical, cognitive or behavioral deficits. Other (please specify) OK Question Title * 4. What day(s) would programming be the most convenient Monday Tuesday Wednesday Thursday Friday Saturday OK Question Title * 5. What time(s) would be the most convenient for programming 9-11 am (weekends) 12-2 pm (weekends) 3-5 pm 6-10 pm OK Question Title * 6. What type(s) of athletic programs would be of interest softball soccer hockey baseball basketball track swimming Other (please specify) OK Question Title * 7. What type(s) of fitness programs would be of interest gymnastics zumba karate dance yoga walking Other (please specify) OK Question Title * 8. What type(s) of art programs would be of interest ceramics arts & craft classes music drama / theatre painting Other (please specify) OK Question Title * 9. What type(s) of outdoor adventure programming would be of interest rock climbing kayaking hiking / walking skiing / snowboarding camping fishing Other (please specify) OK Question Title * 10. What type(s) of social groups would be of interest social skills group games and activities community involvement / volunteering job skills cooking class mentor / men-tee relationships bowling gardening Other (please specify) OK Question Title * 11. Any feedback regarding support, adaptive programs, non adaptive programs etc. OK DONE
