Baycrest Sharing Dance Seniors Survey

What Is Your Name?

First

Last

Postal Code

What is your gender?

Male
Female
Other

Please select your age bracket

How many of the Baycrest-NBS Sharing Dance Seniors at Home classes have you completed?

Please select the option that best describes your situation

I live in a private home
I live in a retirement home
I live in a long-term care facility
I work in a retirement home/long term care facility
Other

Please select the option that best describes how you participated in Baycrest-NBS Sharing Dance Seniors at Home

I danced alone
I danced with my spouse
I danced with a relative or friend (e.g., a parent, a child)
I danced with my caregiver
I am a formal caregiver and I danced with my client(s)

How did you hear about Baycrest-NBS Sharing Dance Seniors at Home?

Canada's National Ballet School website
Baycrest website
Social media
Friends or family members
Newspaper
Other

What would you say was the primary reason for participating in the classes?

Exercise
Something to do
Curiosity
An activity to do with the person I care for
Other

How did you connect to the dance classes?

Phone
Tablet
Computer
TV screen connected to phone, tablet, or computer

How challenging was it to connect to the class online?

Very Difficult
Difficult
Not Difficult
Easy
Very Easy

What did you think about the length of the class?

The class length was too short
The class length was just right
The class length was too long

Please rate your enjoyment of the following class components:

	Not Enjoyable at all	Not Enjoyable	Somewhat Enjoyable	Enjoyable	Very Enjoyable
The types of movements in the class(es)	Not Enjoyable at allThe types of movements in the class(es) Not Enjoyable at all	Not EnjoyableThe types of movements in the class(es) Not Enjoyable	Somewhat EnjoyableThe types of movements in the class(es) Somewhat Enjoyable	EnjoyableThe types of movements in the class(es) Enjoyable	Very EnjoyableThe types of movements in the class(es) Very Enjoyable
The classes' creative themes (e.g., visiting the beach)	Not Enjoyable at allThe classes' creative themes (e.g., visiting the beach) Not Enjoyable at all	Not EnjoyableThe classes' creative themes (e.g., visiting the beach) Not Enjoyable	Somewhat EnjoyableThe classes' creative themes (e.g., visiting the beach) Somewhat Enjoyable	EnjoyableThe classes' creative themes (e.g., visiting the beach) Enjoyable	Very EnjoyableThe classes' creative themes (e.g., visiting the beach) Very Enjoyable
The music used in the class(es)	Not Enjoyable at allThe music used in the class(es) Not Enjoyable at all	Not EnjoyableThe music used in the class(es) Not Enjoyable	Somewhat EnjoyableThe music used in the class(es) Somewhat Enjoyable	EnjoyableThe music used in the class(es) Enjoyable	Very EnjoyableThe music used in the class(es) Very Enjoyable
How the dance teachers presented the classes	Not Enjoyable at allHow the dance teachers presented the classes Not Enjoyable at all	Not EnjoyableHow the dance teachers presented the classes Not Enjoyable	Somewhat EnjoyableHow the dance teachers presented the classes Somewhat Enjoyable	EnjoyableHow the dance teachers presented the classes Enjoyable	Very EnjoyableHow the dance teachers presented the classes Very Enjoyable

What did you think about the level of physical difficulty of the dance classes?

I would have liked it to be more challenging
It challenged me appropriately
I would have liked it to be less challenging

If you danced with somebody else, how enjoyable would you say the dance class experience was for the other person/people you danced with?

Not Enjoyable at all	Not Enjoyable	Somewhat Enjoyable	Enjoyable	Very Enjoyable
Not Enjoyable at allThe music used in the class(es) Not Enjoyable at all	Not EnjoyableThe music used in the class(es) Not Enjoyable	Somewhat EnjoyableThe music used in the class(es) Somewhat Enjoyable	EnjoyableThe music used in the class(es) Enjoyable	Very EnjoyableThe music used in the class(es) Very Enjoyable

Would you participate in this program again?

Yes
Maybe
No

Is there anything else you would like us to know about your experience with this program?

To help inform the development of Sharing Dance Seniors at Home, we would love to know more about your experience. If you are willing to participate in a 15-minute follow-up phone interview, please provide your contact information below.

Full Name

Phone