Youth Development
Healthy Living
Social Responsibility

Youth Program Survey

Name of Class:*
Day of the Week:
Month That Child Took The Class:
Instructor/Coach Name:
Is Child a Male or Female?
Your Name (Completely Optional):
Please indicate your satisfaction with the following areas. The scale is 1 to 5.
'1' is Poor;  '3' is Average;  '5' is Excellent.
Instructor Quality/Knowledge:
Value of Program for the Price:
Schedule/Location Convenience:
Improvement in Participant's Skills:
Emphasis Placed on Sportsmanship:
Social Environment (Peer to Peer):
Safety of the Program:
Level of Fun Your Child Had:
Instructor Communication with Parent:
Cleanliness of Space:
Was Facility Appropriate for Class Activity:
Condition/Availability of Equipment

Do you have any additional Comments? Please let us know if you would like to be contacted by our Executive Director or a member of our Program Committee by including your contact name, phone number and/or email address below. Thank you for your additional comments.

Additional Comments:
This is a captcha-picture. It is used to prevent mass-access by robots. (see:

Please confirm that you are not a script by entering the letters from the image.