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Community Recreation and Special Needs Survey
Please take ten minutes to complete this survey. This survey exists solely as information gathering with the hope of learning what special needs for recreation exist in the West Michigan area. All of the information you share will remain completely confidential. If you would like more information about this survey you may contact Miranda Ward-Gardner, CTRS at miranda@livingwellrt.com
All survey participants will be entered into a raffle for $50 for Dave and Busters!
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Indicates required field
Please Check if you live within a 15 mile radius of Grand Rapids
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Yes, I live within a 15 mile radius of Grand Rapids, Mi
No, I live outside of the Grand Rapids area
What is your zip code
What is your zipcode
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Are you filling this survey out about yourself or someone else
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Myself
Another person
If completing this survey for someone else, who is this person to you:
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My child/stepchuld
My grandchild
My spouse
My friend
My neighbor
Do you believe that recreation is important for everyone
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Yes
No
Unsure
Do you believe recreation can help people live happier lives?
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Yes
No
Unsure
Do you believe that recreation can help people of any ability improve in physical, emotional, social or cognitive skills?
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Yes
No
Unsure
If the person you are completing this survey about has a special need, what is this need:
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Sensory (Autism, Asbergers, others)
Physical (trouble walking, moving, pain)
Cognitive (developmental disability, brain injury)
Emotional (autism, social disorders)
Please share any other information that you are willing
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Does this person regularly receive other therapies
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Yes
No
Once in a while
Never
Check all that apply. If so, what therapies:
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Physical Therapy
Occupational Therapy
Speech Therapy
Behavioral Therapy
How much money does this person and/or their caregivers (family included) invest financially into therapies monthly
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$0 - $100
$100-$500
$500 - $1000
None
More then I would like to think about
How often does this person participate in recreational activities? That can be activities alone, with family or in a class or group in the community
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A couple times a day
Once a day
A couple times a week
Once a week
A couple times a month
Once a month
Almost never
How hard is it for this person to participate in recreation
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It is not difficult
It is sometimes hard
It is always hard
They require someone else help to participate in recreation
What reasons can recreation be difficult for them?
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Their hands don't work well
They can't focus on an activity
They don't do well with others
They don't enjoy much
They want to do things that are physically very difficult
Do you feel there are groups available in the area that they could participate in?
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Yes
No
Unsure
They are not capable
What type of activities has this individual tried before:
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Adapted Sports
Sensory Movies
Social Groups
Hippotherapy (horse therapy)
Inclusion Recreation Programs
Aquatic Therapy in a group
Aquatic therapy individually
Check all that apply. What, if any, activities would this person be interested to learn about or try?
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Adapted Sports, individual sessions
Adapted Sports in a group on a weekly basis
Social Groups occasionally
Social Groups a few times a month
Horse Therapy
Inclusion recreation programs
Aquatic Therapy in a group
Aquatic Therapy one-on-one
Functional Fitness programs
Sensory sports programs
Family Play sessions
Small group play sessions
Adapted Rock Climbing
Water Sports
How much money would this person have to invest in regular recreation
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$5-$10 a week
$10-$20 a week
$20-$40 a week
$40-$60 a week
$10-$40 a month
None
Check all that apply. If there were recreational activities available, how often would this person be willing to participate if they could afford it:
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Daily
Twice a week
Once a week
Twice a month
Once a month
Every two months
Once a year
What is the household income of the home where the individual resides who you completed this survey about?
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Less than $10,000
$10,001 - $25,000
$25,001 - $40,000
$40,001 - $70,000
$70,001 - $100,000
Greater than $100,000
Prefer not to say
If there were grants funds available for recreation would you or someone you know be interested to learn about this:
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Yes
No
Maybe
I would like to learn more about recreational opportunities
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Yes
No
Maybe
I am more interested in recreation opportunities in this setting:
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One-on-one
In a family setting
In a group of no more then three people
In a group of 5-10 people
I am not interested in recreation opportunities at all
Tell us more about recreation and what needs you feel are not being met in the West Michigan Community! Share anything you feel has been missed in this survey or that you would like to share.
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Please contact me about the following
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Grants for recreation opportunities
Sliding scale recreation opportunities
General information about special needs recreation
Family recreation
Adapted recreation
Aquatic Therapy
Small groups
If you would like to be contacted, please put your name and best contact information below. If you do not write your information below your survey remain completely confidential
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If you would like to receive a monthly newsletter about Recreation Therapy please list your email below
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Home
Services
Individual and Family
Groups and Programming
Consultation
What IS Recreation Therapy
Bio
Contact
