Market Potential Survey

1
Would your family be interested in becoming paid members of a recreation center in the greater Chapel Hill area that was open every weekday afternoon and all day weekends — designed specifically to serve kids with autism (and similar neurodivergent conditions) and their families?* This field is required."Similar neurodivergent conditions" includes: Dyscalculia, Dyslexia, Dyspraxia, OCD, Sensory Processing Disorder, Synesthesia, Tourettes, etc.
YESNO
2
How valuable would a community center like Hippo Campus be to your family?* This field is required.
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10
Not valuable
Extremely valuable
3
Which best describes you?* This field is required.
K-12 student who is neurodivergent
Parent/Caregiver of a neurodivergent K-12 student
Other family member of neurodivergent K-12 student
Clinical or community-based service provider
Other
4
Your name* This field is required. All personally identifiable information will remain confidential.
First Name
Last Name
5
Email* This field is required.By providing your email address, we'll be able to send you updates as we get closer to launching.
example@example.com
6
Which type of school do you or your neurodivergent children attend?* This field is required.
Public school
Private or Charter school
Homeschool or alternative school
A combination of Public & Private/Charter/Home schools
N/A
7
Address* This field is required.Tell us which city and ZIP code you live in, so that we can identify the ideal location for Hippo Campus.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
If you feel comfortable doing so, please share which of the following challenges the neurodivergent young people in your life experience regularly.Select all that apply. (Sorry for the long list — I promise this is the last boring question!)
Hard to meet people with similar backgrounds
Difficulty trying new activities
Lack of close friendships
School performance below abilities
Behavioral problems
Loneliness
Exhaustion from trying to fit in
Difficulty mastering certain everyday life skills
Feeling misunderstood
Not enough physical activity
Lack of common interests with peers
Depression
Feeling physically uncomfortable in many places
Difficulty managing or enjoying unstructured free time
Lack of responsibility for chores, jobs, etc.
Concern about life after graduation
Excessive worries, fears, and doubts
Misunderstanding social norms/expectations
Too much screen time or digital scrolling
Difficulty relaxing
Being reclusive, not wanting to leave the house
Resistant to meeting with service providers (OT, speech, tutors, ABA, etc.)
Target of bullying (in-person or online)
Lack of mentorship opportunities (big/little buddies)
Other
9
Do you enjoy playing table/game room games with others who have a similar level of physical abilities?* This field is required.Think of hand-eye active games like foosball, ping pong, etc.
YESNO
10
Which of these table/game room style games would interest you most?* This field is required.If there's one not listed here, you'll have a chance to suggest it at the very end of the survey.
Air Hockey
Bench Soccer
Billiards
Bubble Hockey
Bumper Pool
Cornhole
Foosball
Nok Hockey
Pinball
Pop-a-Shot Basketball
Shuffleboard
Sjoelbak (Dutch Shuffleboard)
Skee-Ball
Table Tennis (Ping Pong)
None of the above
11
Are you interested in fantasy Role Playing Games or other similar card games?* This field is required. Think of binder or "collector" style card games that have a storytelling component.
YESNO
12
Which of the following fantasy/role playing/card games (table-based) are you most interested in playing with others?* This field is required.If there's one not listed here, you'll have a chance to suggest it at the very end of the survey.
Dungeons & Dragons
Magic: The Gathering
Millenium Blades
Mindbug
Pokémon
Radlands
Yu-Gi-Oh!
None of the above
13
Do you enjoy playing board games with others?* This field is required.These are typically folding games that come in a box and are designed for 2 or more players.
YesNo
14
Which of the following board games are you interested in playing with others?* This field is required.
Apples To Apples
Ark Nova
Backgammon
Battleship
Card Games
Checkers
Chess
Clue
Connect 4
Cranium
Everdell
Exploding Kittens
Go
Great Wall
Jenga
Mancala
Marrakesh
Monopoly
Othello
Pandemic
Parks
Pictionary
Qwirkle
Risk
Rummikub
Scattergories
Scrabble
Sequence
Settlers of Catan
Sorry!
Splendor
Sushi Go!
Taboo
Taco Cat Goat Cheese Pizza
Ticket To Ride
Trivial Pursuit
Twister
UNO
Yahtzee
None of the above
15
Are you interested in any instructor-led group activities that are tailored to the needs of neurodivergent kids? Think of any group (or 1:1) "classes" or "lessons" that appeal to you.
YESNO
16
Which instructor-led classes interest you?
Art Instruction
Band / Instrument
Book Club
Chess Club
Chorus / Voice
Cooking & Baking
Dance
Drawing & Painting
Fishkeeping
Group Fitness
Hobby Cars & Trains
Movie Club
Pottery
Puppetry
Radio & Broadcast
Robotics
Science / STEM
Theater & Improv
Yoga
None of the above
17
Are you interested in having unstructured activities that encourage group "free play" or independent work/relaxation/play?* This field is required.
YESNO
18
Which independently-led activities would you like to have dedicated space for?* This field is required. Think of these as always available, "self-serve" or "free play" type areas.
Bracelet & Jewelry
Drawing & Art
Dungeons & Dragons
Indoor Playground
Karaoke
Knitting & Sewing
LEGO
Library Nook
Live Action Role Playing (LARP)
Miniatures
Music Rehearsal
Relaxation / Sensory Space
Study / Work
None of the above
19
How interested are you in enrolling in a licensed after-school program, led by trained staff, catering to neurodivergent kids?* This field is required.
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Not interested
Extremely interested
20
Is there anything we missed? Is there something you think we should try to include? Feel free to be as specific as possible.
Huge
Large
Normal
Small
Ok
Ok
21
Last one: After answering all of these questions about your interests and potential programming, do you feel more or less excited about Hippo Campus?* This field is required.
How excited were you before?
How excited are you now?
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How excited were you before?
How excited are you now?
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