Application Inclusion Support
in Recreation Programming Advisory Group

Halifax Regional Municipality, Parks & Recreation

The Inclusion Support Advisory Group is a team of residents from all over the Halifax Regional Municipality (HRM). It consists of the mixed group of persons with disabilities, parents of persons with disabilities and service providers. This group is leading the development of the Inclusion Support Analysis and Evaluation and ensuring that the key priorities accurately reflect the needs of the disability community in the municipality. This group will help in the creation of a municipality-wide survey, analyze data to determine key issues and guide the recommendations that will make up the final plan. There will be a commitment to attend monthly meeting (outside of July and August) through the end of 2025. Childcare can be provided.

In accordance with Section 485 of the Municipal Government Act (MGA), any personal information collected on this application form will only be used by municipal staff and, if necessary, individuals and/or organizations under service contract with the Halifax Regional Municipality for purposes relating to processing this Inclusion Support in Recreation Programming Advisory Group application form.

If you have any questions about the collection and use of your personal information, please call 311 or email contactus@311.halifax.ca.

If you have any non-privacy related questions about the application or the Inclusion Services Analysis, please contact inclusion@halifax.ca.

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* 1. Full Name of Applicant

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* 2. Email

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* 3. Phone

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* 4. What Community do you live in?

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* 5. Are you from one of the following groups? (Please select all that apply)

Parent of a child with a disability

Parent of an adult with a disability

Individual living with a disability

Service provider for persons with disabilities

Self-Identification (Optional).
Please check each one that you identify yourself as (you can choose more than one).

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* 6. Indigeneity
Indigenous: A collective name for First Nations, Metis and Inuit. Do you identify as an Indigenous person? Indigenous is an umbrella term for First Nations (status and non-status), Métis and Inuit.

Yes

Prefer not to answer

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* 7. Ethnic Identity
What is your ethnic identity? Please check all that apply. Please note that this is a non-exhaustive list of ethnic identities. Ethnicity refers to groups that share a sense of identity, history, cultural roots, and, oftentimes, geography. It is not only connected to race.

African Nova Scotian

African Canadian

Afro-Caribbean

African Descent

European Descent

South Asian (e.g. East Indian, Pakistani, Sri Lankan, etc.)

Latin American (Mexico, Hondouras, Brazil etc.)

Middle Eastern (Egyptian, Iraqi, Syrian, etc)

Acadian

Southeast Asian (e.g. Vietnamese, Cambodian, Laotian, Thai, etc.)

West Asian (e.g. Iranian, Afghani, etc.)

East Asian (Chinese, Japanese, Korean, etc.)

Polynesian (Hawaiian, Samoan, etc.)

Prefer not to say

My ethnic identity is not listed above. Please specify:

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* 8. LGBTQ2+
Do you identify as LGBTQ2S+?

Yes

Prefer not to answer

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* 9. Would you prefer in person or virtual meetings?

Virtual

In person

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* 10. Would you require childcare to attend in person meetings

Yes

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* 11. Have you or your child participated in HRM recreation programming before?

Yes. Please list programs attended:

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* 12. Why would you be a good fit for the Inclusion Support in Recreation Programming Advisory Group?

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* 13. We are looking for a diversity of voices in our Advisory group, how would your experience bring a unique perspective to the Inclusion Support in Recreation Programming Advisory Group?

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* 14. Do you have any accessibility needs? This can include anything you need to feel comfortable, safe, and supported. (i.e., wheelchair accessible venue, ASL interpretation, scent-free space, prayer mats, dietary restrictions, etc.)

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* 15. How did you hear about the Inclusion Support in Recreation Programming Advisory Group?

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100% of survey complete.

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* 1. Full Name of Applicant

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* 2. Email

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* 3. Phone

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* 4. What Community do you live in?

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* 5. Are you from one of the following groups? (Please select all that apply)

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* 6. IndigeneityIndigenous: A collective name for First Nations, Metis and Inuit. Do you identify as an Indigenous person? Indigenous is an umbrella term for First Nations (status and non-status), Métis and Inuit.

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* 7. Ethnic IdentityWhat is your ethnic identity? Please check all that apply. Please note that this is a non-exhaustive list of ethnic identities. Ethnicity refers to groups that share a sense of identity, history, cultural roots, and, oftentimes, geography. It is not only connected to race.

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* 8. LGBTQ2+Do you identify as LGBTQ2S+?

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* 9. Would you prefer in person or virtual meetings?

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* 10. Would you require childcare to attend in person meetings

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* 11. Have you or your child participated in HRM recreation programming before?

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* 12. Why would you be a good fit for the Inclusion Support in Recreation Programming Advisory Group?

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* 13. We are looking for a diversity of voices in our Advisory group, how would your experience bring a unique perspective to the Inclusion Support in Recreation Programming Advisory Group?

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* 14. Do you have any accessibility needs? This can include anything you need to feel comfortable, safe, and supported. (i.e., wheelchair accessible venue, ASL interpretation, scent-free space, prayer mats, dietary restrictions, etc.)

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* 15. How did you hear about the Inclusion Support in Recreation Programming Advisory Group?

* 6. Indigeneity
Indigenous: A collective name for First Nations, Metis and Inuit. Do you identify as an Indigenous person? Indigenous is an umbrella term for First Nations (status and non-status), Métis and Inuit.

* 7. Ethnic Identity
What is your ethnic identity? Please check all that apply. Please note that this is a non-exhaustive list of ethnic identities. Ethnicity refers to groups that share a sense of identity, history, cultural roots, and, oftentimes, geography. It is not only connected to race.

* 8. LGBTQ2+
Do you identify as LGBTQ2S+?