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Short Breaks Service Feedback Form

We would like your views and opinions on the Short Break service you have received so that we can continue to develop the required service in line with what you need and would want for the future. Please take the time to complete the survey below and provide us with that feedback.

Parent/Carer's Name
First Last
Email
Name of child
Gender of child
Age of child
What category of disability your child fall in to?
If C, please state what the disability is.
Does your child have a Health Care Plan
Which provider did your activity take place with?
How long did your activity last?
For the series of questions below, please use the following rating scale:
1. Excellent
2. Good
3. Satisfactory
4. Poor
Were the activities well advertised and easy to find?
How easy was it to book activities?
How suitable was the venue and location?
How well were your child’s health needs met?
Was the Short Break service worker polite and helpful?
How suitable was the Short Break service to your child’s needs?
How would you judge your child’s enjoyment?
How suitable was the Short Break service to your child’s needs?
Please rate how these Short Break services made a difference to your child?
How much did you pay for your activity?
Please rate how these Short Breaks have helped you as a parent/carer?
Were you happy with the cost for Short Break activity?
Would you pay an additional fee for a Short Breaks Activity for your child/ young person depending on the activity?
Taking all this information into account, please give an overall score to show your level of satisfaction.
What Short Breaks Services have you used in Slough?
Do you access the below universal services below (please tick all that apply)
- Children's Centres
- The Centre (new leisure centre)
- Ice Arena
- The Curve
- Max Card
- Libraries in Slough
- Salt Hil Activity Centre
- Autism Berkshire Service
- Slough Family Information Resource Support Team
- Schools in Slough
Do you have any further comments you would like to add?
Data Protection

Under the Data Protection Act 2018, we are required to gain your permission to keep personal details for you.

Any details provided on this form will be used to improve our offering only, and will not be passed on to third parties. Information will be treated in accordance with current Data Protection legislation.

For further information please read our Privacy Policy. By completing this form and clicking the submit button, implied consent is given to us holding your data. If you have a query in relation to fair processing, please email information@sloughchildrenfirst.co.uk

Thank you for your feedback. It is valuable and we appreciate your input.

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Slough Children First
Observatory House
25 Windsor Road
Slough
Berkshire
SL1 2EL

General enquiries: 01753 477321
Concerns about a child: 01753 875362

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