Family Matters

Family Questionnaire

We are seeking your input to help us identify the kinds of information and events that would be helpful to families/advocates of children who are served by MAPCL. We will be keeping track of this information and using it to identify areas of need.

Does your family member receive our services for: Adults Children
What service(s) does your family member currently receive from MAPCL? Please identify a few topics that are important to you and about which you would like more information. (e.g. Autism, Fetal Alcohol Spectrum Disorder, positive parenting, transition planning [Kindergarten—Elementary School—High School], addressing challenging behaviours, future planning, service options, setting up estates/trusts, Registered Disability Savings Plan, Representation Agreements, advocacy, social networks). If your family member between the ages of 6-18, would you be interested in his/her participation in a Social Skills Group (building communication and self-confidence through positive peer experiences)? Yes No N/A Do you think the siblings (ages 6 – 18 years) of your child with a disability might be interested in participating in a Sibling Group (to obtain peer support and education, in a recreational setting)? Yes No N/A Are you interested in attending workshops or information sessions? Yes No Do you need child-minding at the workshop/session sites? Yes No Sometimes Do you prefer Weekend or Weekdays Do you prefer Daytime or Evenings Is there anything else we should consider in enabling you to attend our workshops / sessions? If you are interested in meeting other families, how would you prefer to do so (e.g. social events, support groups, email or networking site) On occasion, we may be able to provide workshops in another language. Which language would you prefer? If you would like to receive information from MAPCL or notices about upcoming workshops or events, please provide relevant contact information.
Name
Address:
Home Phone:
Fax:
Email Address:
How would you prefer th at we contact you? Mail Phone Fax Email
Thanks for taking the time filling out this information form. Please be assured that your information is kept confidential and will never be shared with anyone.