Do Disability Differently Book Survey

1
Full Name (Parent/Carer, if applicable)
First Name
Middle Name of
Last Name
2
Full Name (Child/Young Person)
First Name
Middle Name of
Last Name
3
Age (Child/Young Person)
4
Gender assigned at birth (Child/Young Person)
Please Select
Please Select
Male
Female
Prefer not to say
5
E-mail (Parent/Carer)
example@example.com
6
Tell me a little bit about you. ((Child/Young Person)
7
What does the word disability mean to you? (Child/Young Person)
8
Do you have a disability or neurodiversity? (Child/Young Person)If yes, please feel free to share any details you would like to share.
9
What are you good at? (Child/Young Person)
10
How does what you are good at make your life better? (Child/Young Person)
11
What makes your life more difficult? (Child/Young Person)
12
How does that make you feel? (Child/Young Person)
13
If you had a magic wand, which challenges in your life would you fix first? (Child/Young Person)
14
If your magic wand worked, how would your life change? (Child/Young Person)
15
What is important to you that you want other people to know? (Child/Young Person)
16
What would make your life even better? (Child/Young Person)
17
What does ‘do disability differently’ mean to you? (Child/Young Person)
18
Please feel free to share if you have any more thoughts. If you are a family member, please feel free to add any context or thoughts that you feel relevant. (Either Child/Young Person, Parent/Carer or both)
19
Are there any questions you would like to see added to this form?
Should be Empty: