CWC Event Online Check-In
Community Wellness Connections thanks you for participating in our event!
We hope you had as much fun attending as we did organizing it.

We want to hear your feedback so we can keep improving our logistics and content. Please fill this quick survey and let us know your thoughts (your answers will be anonymous).

Name (First & Last) & Email Address & Phone Number *
You may check-in for your family; please just fill in only your name here and contact information .
Your answer
I am completing this for: *
I am checking-in to this event (include date & location) *
(You don't need the exact event name--summarize as best you can)
Your answer
Age Demographics
ONLY report for the individual(s) who attended the event
1 person
2 persons
3 persons
4 persons
5+
Under 18
19-29
30-39
40-49
50-65
65+
Which of the following best represents your racial or ethnic heritage? Choose all that apply.
If you are completing this for yourself, please select "1 person" in the categories listed below.
1 person
2 persons
3 persons
4 persons
5+ persons
Non-Hispanic White or Euro-American
Black, Afro-Caribbean, or African American
Latino or Hispanic American
East Asian or Asian American
South Asian or Indian American
Middle Eastern or Arab American
Native American or Alaskan Native
Other
Interested in being eligible to win a prize?
Every time you attend an event complete this form to check-in, you will be entered to win one of many wellness prizes (with completion of Pledge Form) for every two events you attend ! A Pledge Form must be completed in addition to this form to be entered into prize drawings. Pledge Forms can be obtained by visiting www.adamswellness.org.
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