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Short breaks survey

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About you and your family

Maximum 255 characters

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Please note this questionnaire is only for residents of Barking and Dagenham
Select option
If answering for multiple children, please select "multiple ages" at the bottom of the list and use the freetext box to state their ages
3.  

How would you describe your child's / children's disability? (Please select all that apply)

If answering for multiple children, please tick all which apply and use the "Other" box to provide information of which children: eg (one has visual impairments, one has learning difficulties)
4.  

How many children do you have who have special needs and/or a disability?

If you are answering for more than one child please select all options which apply to your children throughout the survey use the free text responses throughout to describe differences in your experiences, including the experience of caring for multiple children with disabilities or special needs.
5.  

Do you have any other children who do not have special needs and/or a disability?