The Busy Brains Children's Museum is beginning to prepare the site and permanent exhibits. The museum values input for special needs families that will be visiting the museum. Please take the time to fill out the survey. On March 1, 2010, we will randomly pull one survey. That lucky winner will receive a gift certificate to create a tile (in the comfort of their own home), which wil be displayed in the permanent museum. Want a more crucial role in developing the Busy Brains Children's Museum? Contact: Kathy Goers for information on active committees.

Name (optional):
City of residence (optional):	State: Illinois Indiana Michigan Wisconsin Other
Phone Number (optional):
Email Address:
Are you interested in receiving updates on the museum via emails? Yes   No
What type(s) of special needs does your child have?
When you visit public places as a family, what is important to you?
What would make your public visit more comfortable?
Have you ever attended a children's museum? Yes   No
If yes, what did you like about it?
If yes, was there anything about the experience that you did not like?
What part of public places (entry way, restrooms, hallways,etc.) are most difficult for your child?
Does your child have any fears/anxieties that you would want communicated with a children's museum?
What could a children's museum do to help support your family's needs?
May we contact you for further information, or to possibly join in a focus group discussion? Yes   No
What type of sensory stimulation (auditory, tactile, visual) most benefit your special needs child?
Would having special museum hours for special needs children be beneficial for your family? Yes   No
Any additional comments/concerns?

 

Thank you for filling out this survey. Your input is crucial in the development of Busy Brains Children's Museum.

Kathy Goers	Alison Price
Co-founder	Co-founder