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Activity Interest Form
1.
Parent/Guardian Information
Name
Child's Name(s) & Age(s)
Contact Email
Contact Phone
2.
Please rate your child's level of interest in the following activities.
(1 = No Interest, 2 = Some Interest, 3 = Interested, 4 = Very Interested)
1
2
3
4
Vocal Performance
1
2
3
4
Guitar Lessons
1
2
3
4
Piano Lessons
1
2
3
4
Theater Acting/Drama
1
2
3
4
Dance Lessons
1
2
3
4
Golf Lessons
1
2
3
4
Tennis Lessons
1
2
3
4
Basketball Skills Lessons
1
2
3
4
Batting Lessons
1
2
3
4
Sports Performance Training
1
2
3
4
Speed & Agility Training
1
2
3
4
Swimming
1
2
3
4
3.
Which days work the best for your family to participate in activities?
(Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
4.
Preferred time for activities
Morning (9a-12p)
Afternoon (12-3p)
Late Afternoon (3-6p)
Evening (6-8p)
5.
Are there any other activities you would like to see offered at Joint Base Charleston Weapons Station for youth?
6.
Additional comments or concerns
Current Progress,
0 of 6 answered