Youth Development Survey
For parents/guardians
Name *
Your answer
Address *
Your answer
Waiver and Release *
Required
Photographic Release *
Required
Are you expecting a child (pregnant)? *
What is the gender and age of your child(ren)
Boy
Girl
Under 5
Age 5-8
Age 9-12
Age 13-15
Age 16-18
First Child
Second Child
Third Child
Fourth Child
Fifth Child
Sixth Child
Which workshop(s) would you like your child(ren) to participate?
Conflict Resolution
Coding
Financial Literacy
Robotics
Etiquette
Reading
Drug Prevention
First Child
Second Child
Third Child
Fourth Child
Fifth Child
Sixth Child
Which activities would you like your child(ren) to participate?
Volleyball
Chess
Martial Arts
Theatre
Basketball
Dance
Cooking
Photography
Football
First Child
Second Child
Third Child
Fourth Child
Fifth Child
Sixth Child
What school does your child(ren) attend?
Clark Elementary
Marquette
St. Clare of Montefalco
Ronald Brown
Chandler Park Academy
East English Village Prep
Denby
Other
First Child
Second Child
Third Child
Fourth Child
Fifth Child
Sixth Child
When would you prefer youth development activities be held? *
Required
Does your child(ren) have reliable transportation to participate in after school (5-8pm) or weekend activities? *
Are you interested in helping us create new programs for the youth in our community? *
What are your greatest family needs?
Email address (to receive program updates)
Your answer
Cell Number (for text updates)
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy