Pre-Registration Pre-registration for the St. Coletta Intergenerational Care Center How soon will your loved one be needing day programming?ImmediatelyFall 2018Spring 2019Fall 20192020 or laterWhat age currently is your loved one?18 - 2122 - 3031 - 4950 - 5960+Which program(s) sounds like it may be the best fit for your loved one?Excel Day Program (ages 18-50+) which focuses on social activitiesGenesis Young Adult Day Program (ages 18-30) which prepares students for community employment.Golden Options Day Program (ages 50+ and/or those who are medically fragile) for seniors with or without disabilities.Please answer the next three questions based on your knowledge of the services in the area."Parents and guardians of individuals with developmental and intellectual disabilities need reliable respite services."Strongly AgreeAgreeDisagreeStrongly Disagree"Parents and guardians of individual's with developmental and intellectual disabilities are in need of respite services."Strongly AgreeAgreeDisagreeStrongly Disagree"Brookfield and the surrounding areas need more residential housing options for residential individuals with developmental disabilities."Strongly AgreeAgreeDisagreeStrongly DisagreeDuring day programming hours, which services and activities would you most like to see offered? (Please check your top 3) Swimming Physical fitness and yoga Sports Arts and crafts Pet programs Music programs Volunteer opportunities Social skill building Financial and budgeting education Independent living skills Job development Recreation / community outing Regarding respite opportunities for parents and guardians, when would you be looking to utilize those services? Choose all that apply. Weekdays Weekday nights Weekends Specifically during the summer months Throughout the entire year What other types of post-high school services and supports do you feel are still needed in the Brookfield area? This could be for those with disabilities, students, senior citizens, children, or others in the community.Would you be interested in extended or wrap-around programs for school-aged children? Please check all that apply: Before school After school Weekends School holidays Summer Thank you for taking our survey! Please feel free to use the following text box to include any additional information you'd like to share OR if you are interested in having a representative calling you, please include your name and phone number.