PRE-EVENT SURVEY

Please fill in as much information as you can on this form to assist Disability Sports Australia in assisting you the participant and the family, carer, guardian, or teacher in helping the participant reach their social activity goals.

First Name

Last Name

School

Age

State

Identified Gender

Male

Female

Non-Binary

Would rather not say

Disability Type (please select the most appropriate below)

Physical: Cerebral Palsy

Physical: Quadriplegia

Physical: Paraplegia

Physical: Amputee

Physical: Short Stature

Sensory: Deaf or Hard of Hearing

Sensory: Vision Impairment / Blind

Intellectual: Autism

Intellectual: Down Syndrome

Other

If other, please specify.

Does the participant currently participate in PE at school?

Yes

Does the participant currently participate in sport outside of school?

Yes

How does being active make you feel?

Confident

Excited

Worried

Sad

Would the participant like to continue to do any activities within their community after they attend Activate Inclusion Sports Day?

Yes

If yes, please list 3 sports or recreation activities the participant would like to try

Disability Sports Australia will link you with opportunities available in these activities through our National Referral Hub

Name

Relationship to Participant

Phone

Thank you for completing this feedback form.

Information provided will be only used by Disability Sports Australia and our AISD partners to improve service delivery quality.

About Us

Disability Sports Australia aim to connect Australians with disabilities to their local adaptive sport and recreational opportunities. The Activate Inclusion Sports Days is one program DSA delivers with partners to get more people with disabilities to be more active, more often.

Upcoming Events

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