Cody Rouge Cares Interest Form

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Cody Rouge Community Action Alliance is working to plan some programs and services for people in the community who are caregivers.If you are a caregiver of someone in Cody Rouge, or if you live in Cody Rouge, we would love to hear from you. Your answers will be anonymous and will just be used to help us create the program schedule.

What kinds of activities would be helpful to you as a caregiver?

Self-care days

Wellness coaching

Healthy eating classes

Cooking demonstrations

Minor home repair services

Chore services

Painting parties

Support groups

Resource fairs

Programs for male caregivers

Caregiver celebrations

Respite care

Dementia education

Exercise classes

Other:

If you were going to attend a class, what days and times would be best for you?

Weekday morning

Weekday afternoon

Weekday evening

Saturday morning

Saturday afternoon

Sunday morning

Sunday afternoon

Depends on the week

Other:

Would you like the activities to be for caregivers and the person that they care for or just for caregivers?

Caregivers and recipients

Just caregivers

Clear selection

If the class were just for caregivers, would you need care to be provided on site for the person that you care for?

Maybe

Yes

Clear selection

What zip code do you live in?

48228

Other:

Clear selection

What zip code does the person that you care for live in?

48228

Other:

Clear selection

Would you be willing to talk with me for a few minutes about what kinds of foods you would like to receive? Your answers will be anonymous and will just be used to help us plan the distributions.

Is there anything else that you would like CRCAA to know?

Submit

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