Needs assessment questionnaire
Disabled persons :
S.A.É - S1.05 - But Informatique 1 2023/2024
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General informations :
General informations :
Name:
First name :
Email :
Your age :
Your phone number:
Number of people:
What type of disability do you have ?
Level of mobility :
Choose
Wrong
Medium
Good
Do you need help getting around?
Yes
No
Do you need special travel equipment?
Yes
No
If you answered "yes" to the previous question, please specify the specific equipment you need to travel:
Preferences :
Category :
Choose
Other
Apartement
AIRBNB
Bed & Breakfast
Campsite
Hotel
Number of rooms and beds
Number of rooms :
Number of beds :
Facilities and services available
Swimming pool
Gymnasium
Restaurant
Date and duration of stay
Arrival date
Number of days
Services de transport
Private transport
Public transport
Food requirements (falcutative)
Budget
Less than 100€
100€ - 500€
500€ - 1000€
1000€ - 1500€
More than 1500€
Special needs
Validate form