Family Accessibility & Support Questionnaire

About You

Tell us who is completing this questionnaire.

Your name *

Email address *

Phone number

Why are you completing this form? *

Parent/Caregiver Educator/Professional Both Other

Parent & Caregiver Input

Please tell us what would help your family member enjoy the Cousins Family Vacation.

Family member's first name

Age at the time of the vacation

What would help this family member feel comfortable, included and able to enjoy the vacation?

Would a quiet or sensory-friendly retreat space be helpful?

Yes Maybe No

Which supports might be useful? Check all that apply.

Food-related needs or considerations

Communication methods or supports we should be aware of

What works well when this family member becomes overwhelmed or needs a break?

Is there anything we should avoid doing that could make participation harder?

Anything else you would like F49A to know?

May an F49A board member contact you privately with a planning question?

Yes No

Family Expertise & Experience

We would love to know who in our family has relevant professional, educational or substantial caregiving experience.

Do you have experience supporting children or adults with autism, developmental disabilities, sensory differences or related needs?

Yes No

Briefly tell us about your experience

No credentials or documentation are required.

Would you be willing to help F49A in any of these ways?

Give planning advice Review the sensory/accessibility plan Suggest supplies/resources Help design the quiet/sensory space Help create a visual schedule Help during an activity if available Be a general resource to the Board Share experience but no volunteer role

May F49A contact you about helping with this part of the Cousins Family Vacation?

Yes No

EVERYBODY ON BOARD

Join the Planning Circle

Everybody On Board Planning Circle is the family working group helping F49A think through sensory, communication, accessibility and family-support details for the Cousins Family Vacation. You do not need a professional title or credential. Parents, caregivers, educators, family members with lived experience and anyone who wants to help are welcome.

Yes, I’d like to join the Everybody On Board Planning Circle and help shape sensory, communication, accessibility and family-support planning for the Cousins Family Vacation.

Anything you would especially like to help with?

Privacy & Responsibility

Information provided here is intended to help F49A plan the Cousins Family Vacation. Please do not submit medical records, insurance information or other documents. F49A is not providing professional childcare, medical care or one-to-one supervision. Parents and caregivers remain responsible for their children and family members throughout the vacation.

I understand how this information will be used and choose to submit it for Cousins Family Vacation planning. *

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