Adult Roller Hockey
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1. Default Section
*
1
. Today's Date:
MM
DD
YYYY
MM/DD/YYYY
Today's Date: MM/DD/YYYY Month
/
Day
/
Year
*
2
. What night do you participate in our program?
What night do you participate in our program?
Monday
Tuesday
Wednesday
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3
. What session did you participate in?
What session did you participate in?
Winter
Spring
Summer
Fall
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4
. How did you hear about the program?
How did you hear about the program?
Program Guide
Past participation in other Community Center Programs
Family/ Friend
Website
Other
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5
. Please rate the program in which you participated in:
Excellent
Good
Fair
Poor
Overall Experience
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Please rate the program in which you participated in: Overall Experience Excellent
Overall Experience Good
Overall Experience Fair
Overall Experience Poor
Customer Service
Customer Service Excellent
Customer Service Good
Customer Service Fair
Customer Service Poor
Quality of the Facility
Quality of the Facility Excellent
Quality of the Facility Good
Quality of the Facility Fair
Quality of the Facility Poor
Program/ Instruction
Program/ Instruction Excellent
Program/ Instruction Good
Program/ Instruction Fair
Program/ Instruction Poor
Value received for my money
Value received for my money Excellent
Value received for my money Good
Value received for my money Fair
Value received for my money Poor
Comments/ Suggestions
6
. Should the program be offered again?
Should the program be offered again?
Yes
No
7
. Gender of participant:
Gender of participant:
Male
Female
8
. Age of Participant:
Age of Participant:
*
9
. Team Name:(Receive $5 off your next season league fees for each player who participates up to $50.)
Team Name:(Receive $5 off your next season league fees for each player who participates up to $50.)
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