Everyone Belongs Survey

First Name Please enter valid data.

Last Name Please enter valid data.

Email Please enter an email address.

1 - Do you or someone in your family have a disability that impacts participation at Jesus the Divine Word liturgical services, parish programs, or other activities?

Conditions might include (but certainly are not limited to) physical, intellectual, developmental, cognitive, sensory, visual, hearing and mental health conditions that limit a person's ability to participate in the Mass or Parish activities. Yes No

If yes, how can we help?

2 - Check all the age group(s) of you and/or family members with disabilities. 5 and under 6-13 14-21 22-39 40-59 60-74 75+

3 - Are you or someone in your family homebound? Yes No

4 - Please use the space below to share information about the type of disability or limitation.

5 - Check all difficulties you or your family member(s) face. Check all that apply. Attending Mass Accessing the Sacraments Participating in the Parish Religious Education Program Participating in our social events or parish ministries Transportation Other

If other, please note it below. Please enter valid data.

6 - Use the space below to share any additional information about how your participation or your family's participation at Jesus the Divine Word is impacted by disabilities.

Parish support for your family

7 - Select all that apply. I am interested in becoming a part of the Everyone Belongs Ministry. I am looking for fellowship and/or a support group with other families. I am interested in enrolling my child in the Religious Ed program with accommodations or supports. I would like the Everyone Belongs Ministry to reach out to me.

8 - Please use the space below to share additional comments or details on how the parish could better serve your family.

Such information could include identifying potential accommodations that would help you and your family more fully participate at Jesus the Divine Word, or suggesting potential ministries, classes, or events.

Jesus the Divine Word Catholic Church

Huntingtown, MD

Everyone Belongs Survey

Everyone Belongs Parish Survey