2. Adaptive Recreation Needs Assessment
   Brownsville Parks and Recreation Department is known for its welcoming atmosphere, family-friendly events and beautiful parks. Our department strives to ensure that all members of the community enjoy our facilities and activities. Currently, we are reaching out for input related to activities for individuals with disabilities. Your input is valuable and will be considered as we expand our program
4. I am completing this survey on behalf of: (select all that apply)*

   1. Self, over 18 years old
   2. Self, under 18 years old
   3. A child under my care
   4. An adult under my care
6. Have you or someone in your household, participated in a City of Brownsville Parks & Recreation program/activity/event in the past? *

   1. Yes
   2. No
8. At what facility? (select all that apply)*

   1. Downtown Rec Center
   2. Brownsville Golf Center
   3. Brownsville Events Center
   4. Brownsville Sports Park
   5. Ringgold Civic Pavilion
   6. Oliveira Gym
   7. Gonzalez Gym
   8. Other Facility/Event:
9. If you selected other, please list:
11. Are you interested in participating in adaptive programming? If so, what would you like to see and how often would you attend an adaptive program of your interest if it were offered?
13. On average, how often do you participate in physical activity or exercise 30 minutes or more? *

    1. 1 time/week
    2. 2 times/week
    3. 3 times/week
    4. 4 times or more/week
15. Do you need someone to assist you in physical activities?*

    1. Yes
    2. No
17. Do you currently have assistance?*

    1. Yes
    2. No
19. Do you have a mode of transportation? If so, what is your mode? (list: car, bus, assistant who drives etc.)
21. Do you use a wheelchair or other aids to assist you in your daily activities? If so, what aids do you use?*
23. Please select potential barriers to participating in adaptive programming: (select all that apply)*

    1. Expense of program
    2. Expense of equipment to participate in program
    3. Need for instruction
    4. Need for assistance/care giver availability
    5. Lack of knowledge for adaptive programming
    6. Other:
24. If you selected other, please list:
26. What do you want your adaptive experience to include? (select all that apply) *

    1. Positive encouragement
    2. Motivation to participate
    3. Assistance setting goals & tracking progress
    4. Identifying barriers from participation
    5. Referrals to activities of additional interest
    6. Education on the health benefits of participating in adaptive programming
    7. Education on safe participation
    8. Education on adaptive equipment
28. I would like the program to be given by: (select all that apply) *

    1. A peer with a disability
    2. An instructor with a healthcare back ground
    3. An individual who is active in adaptive sports and recreation
    4. A website I can access additional online information and resources
    5. Other:
29. If you selected other, please list:
31. Please select the health outcomes of interest to you: (select all that apply). *

    1. Improve function for daily tasks
    2. Improve fitness
    3. Weight loss
    4. Decrease pain
    5. Meet new people/socialize
    6. Improve ability to compete/sports competition
    7. Job skills
    8. Other:
32. Other:
34. What are the best times for you to participate in recreational classes or programs? (select all that apply)*

    1. Weekday mornings (7-11 am)
    2. Weekday afternoons (12-3 pm)
    3. Weekday evenings (6-8 pm)
    4. Weekend morning (7-11 am)
    5. Weekend afternoons (12-3 pm)
    6. Weekend evenings (6-8 pm)
    7. Other:
35. Other:
37. Do you currently participate in any adaptive recreation programs? If so, please specify what, where, when?
39. Select programs you would like to see offered for adaptive programming…(select all that apply)*

    1. Swimming, adaptive aerobics, strengthening and stretching, mobility exercises
    2. Fitness activities such as mobility, strength and endurance training
    3. Group Fitness classes such as adaptive aerobics, wheelchair Zumba, wheelchair tai chi, adaptive yoga, or youth wheelchair games
    4. Group sports such as wheelchair basketball, volleyball, or pickle ball
    5. Social programs such as luncheons, wheel chair dances, family support programs, art, or music programs
    6. Other:
41. Other:
45. Optional Section:
47. Name
48. Email Address
50. Address
52. Phone Number
54. Do you want to be added to our list for future updates and information?

    1. Yes, please add me.
    2. No, thanks. I do not want to be added to any lists.
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

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