CCHA Youth Program Feedback Form
This questionnaire is for families of youth participating in the CCHA Youth Programs (Kids in Action, Adventures in Leadership, Teen Szene, and Cortes Cougars Sports. We really need your feedback in order to improve the programs and meet the needs of our youth participants and their families. If you feel it's appropriate we encourage you to fill this form out with your child/youth''s input!

Everyone who completes the questionnaire will be entered in a raffle to win a $30 gift certificate to the Cortes Natural Food Co-op. We want to preserve anonymity so you can be as open as possible with positive and negative feedback. In order to enter the raffle, you will need to send separate email to Jodi Peters at:, with your name and contact info, letting her know you have completed the form. Thanks!!

How often does your child/youth attend CCHA youth programs?
Please check off which program(s) your youth attends
What are your child's favorite activities offered by this program? (if more than one program, please identify which program the activities pertain to)
Your answer
What are some activities/programming options you or your child/youth would like to see offered by this program, that were not currently offered? (Please list):
Your answer
Are there any activities that your child/youth does not enjoy or feel comfortable participating in? (please list):
Your answer
Ho do you keep up to date with the current program activities and locations? (i.e. monthly flyers, Tideline, CCHA website, community posters, Facebook, word of mouth, coordinator emails, other?) Please list all the ways you use:
Your answer
How would you rate the accesibility of this program (i.e. ease of attending/transportation, activities feel accessible to your child/youth) Check the box next to your answer
"Needs Improvement" Details (use this space to add any details regarding your answer to the above question)
Your answer
How would you rate the inclusiveness of this program (welcoming of all children/youth on Cortes Island in the age appropriate range). Check the box next to your answer
Needs Improvement details (use this space to add any details regarding your answer to the above question)
Your answer
Do you have any additional comments regarding the program(s) your child/youth attends?
Your answer
Do you have any suggestions for other types of programming you feel would be valuable to Cortes youth?
Your answer
Thank YOU! We really value ALL your input (positive and negative). Please be sure to send an email to Jodi at "" with your name and contact information in order to be entered into the raffle. We would like this questionnaire to remain anonymous to encourage the most open feedback.
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