Workshop Accessibility and Allergy Survey
Help us ensure an inclusive and safe workshop experience by sharing your accessibility needs and dietary restrictions.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any accessibility requirements? (Select all that apply)
Wheelchair access
Sign language interpretation
Assistive listening devices
Materials in large print
Materials in Braille
Easy-read materials
Assistance with mobility
Other (please specify)
Please rate how important accessibility accommodations are for your workshop participation.
*
Not important
1
2
3
4
Very important
5
1 is Not important, 5 is Very important
Do you have any allergies or dietary restrictions?
*
Yes
No
Please specify your allergies or dietary restrictions (if any):
Are you comfortable with the workshop environment (lighting, scent, noise, temperature)?
*
Yes, I am comfortable
No, I have concerns (please specify below)
If you have concerns about the workshop environment, please specify:
Preferred format for workshop materials
Please Select
Standard print
Large print
Braille
Digital (PDF, Word, etc.)
Audio
Other (please specify)
Emergency Contact Name and Phone Number
Is there anything else you would like us to know to make your participation comfortable and safe?
Submit Survey
Should be Empty: