Arcadia Village Survey Step 1 of 5 20% Are you taking this survey for yourself or someone else?* For myself. For my spouse or partner only. For myself and my spouse/partner. For one of my parents. For both of my parents. Current AgePlease provide your current ageAge of Second PartyPlease provide the age of the second party (spouse, partner or parent)Please enter a value between 20 and 120.When are you retiring?* Currently Retired One or Two Years Time Three to Five Years Time Six to Ten Years Time More than Ten Years Time What is your current living arrangement? Living in a home/apartment that I own Living in a home/apartment that I rent Living with family. Living in a seniors residence. Which area(s) of Vancouver Island would you like to retire to?*For more than one selection, select and hold down the CTRL key in PC (Command Key in Mac)Courtney/Comox areaNanaimo areaCowichan areaVictoria areaSalt Spring Island/Gulf IslandsOther areas of Vancouver Island What aspects of Arcadia Village most interests you?*For more than one selection, select and hold down the CTRL key in PC (Command Key in Mac)Please select all that apply.Living more cooperativelyLiving close to the land (gardening and growing food)Wellness based lifestyleContributing and volunteeringLower monthly living costsLife-lease lower costs than buyingLearning new skillsSharing what you know with othersPreparing and sharing meals togetherShared values and philosophyStaying healthy by staying active and usefulCooperative legal structureWhat types of activities could you see yourself enjoying with others?*(Choose all that apply)Walks/nature connectionGardeningFarmingWoodworkingCooking/Food PreparationBeekeeping/Candle-makingKnitting/Sewing/WeavingPainting/DrawingSculpture/PotteryTheatre/ActingDance/MovementYogaConversationSpiritual StudyTennis/Lawn SportsBoard Games/Card GamesWhat types of skills do you have that you would be willing to share with others at Arcadia Village?For more than one selection, select and hold down the CTRL key in PC (Command Key in Mac)GardeningFarmingWoodworkingCooking/Food PreparationCleaning/Home MakingBeekeeping/Candle-makingKnitting/Sewing/WeavingPainting/DrawingWriting/PoetrySculpture/PotteryTheatre/ActingDance/MovementYogaConversationSpiritual StudyTennis/SportsBoard Games/Card GamesDo you or your spouse/partner have any health challenges for which you are currently seeking treatment?For more than one selection, select and hold down the CTRL key in PC (Command Key in Mac)Hearing impairmentVision impairmentMobility issues (require cane, wheelchair etc)ArthritisDiabetesAlzeimersHeart IssuesMental health issuesOther How much can you afford to pay to stay at Arcadia Village per person per month?(for single unit Includes accommodation and healthy meals. double units approximately 50% more) Under $1000 $1000 to $1499 $1500 to $1999 $2000 to $2499 $2500 or more How much can you afford to pay to stay at Arcadia Village per couple per month?(for double unit Includes accommodation and healthy meals) under $1500 $1500 to $2000 $2000 to $2500 $2500 to $3000 $3000 to $3500 $3500 to $4000 $4000 or more How much could you afford to pre-pay for the life-lease? (Price will determine size of unit)A life-lease is an upfront pre-paid amount that would be used to help build Arcadia Village. Every year 18% to 20% of the lease fee would be charged on the balance. If the member left Arcadia Village they would be entitled to whatever funds remained in their life-lease. I can not afford a life-lease $50,000 to $60,000 $60,000 to $70,000 $70,000 to $80,000 $80,000 to $90,000 $90,000 to $100,000 $100,000 to $120,000 $120,000 to $140,000 $140,000 or more Would you be interested in volunteering time within Arcadia Village? No Yes, one to five hours a week. Yes, six to ten hours a week. Yes, 11 to 19 hours a week. Yes, 20 to 29 hours a week. Yes, 30 or more hours a week. Name* First Last Email Address* Enter Email Confirm Email Phone NumberPlease provide your phone number if you would like us to stay in touch by phone using format (123)123-1234In which city are you currently living?*Would you like to be contacted for an information event in your area? Yes, please contact me. No, I'm not interested. Are you interested in volunteering time to help start an Arcadia Village in your prefered area? No Yes, one to five hours a week. Yes, six to ten hours a week. Yes, 11 to 19 hours a week. Yes, 20 to 29 hours a week. Yes, 30 or more hours a week. What types of skills would you be able to contribute to help launch Arcadia Village?For more than one selection, select and hold down the CTRL key in PC (Command Key in Mac)Administration/Organizing CommitteeNetworkingPublic RelationsLocal event organizingFund raisingReal estate/land developmentMarketingDo you have any other resources that you might (given the right conditions) be willing to contribute to help develop Arcadia Village?Do you have any questions that we can answer?Do you have any other thoughts or comments? This iframe contains the logic required to handle AJAX powered Gravity Forms.