This survey is to help determine the current and future needs for adult respite services in the Kitimat and Terrace area.  The information gathered from this survey will assist in the advocacy of promoting improved housing opportunities for Special Needs adults.

Question Title

* 1. Would you utilize adult respite services either now or in the future?

Question Title

* 2. When do you foresee needing adult respite services?

Question Title

* 3. What age are your current special needs dependent(s)?

Question Title

* 4. How often would you use this service?

Question Title

* 5. What type of respite would you require?

Question Title

* 6. Would you be willing to contribute toward the use of respite?

Question Title

* 7. Would you be willing to travel to either Kitimat or Terrace to receive this service?