Township of Verona Department of Recreation Office of Special Services Survey

1.Participant's Gender
2.Participant's Age
3.If in school which school does the participant attend
4.Sports of Interest for the participant - Please Select all that apply
5.Recreation/Leisure activities of interest- Please Select all that apply
6.Preferred days of the week for activities
7.Time of day preferred for activities
8.Types of programming preferred
9.Disabilities of participant - Answer optional or select all that apply
10.Which of the following creates the greatest barrier to participating in recreation or sports activities
11.If you or your child has participated in Verona recreation programs in the past, please tell us what your experience was like
12.If you would like to be contacted for future programs or announcements please leave your name, email address, and best contact phone number