Activity Interest Form

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* 1. Parent/Guardian Information

Name

Child's Name(s) & Age(s)

Contact Email

Contact Phone

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* 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	Vocal Performance 1	Vocal Performance 2	Vocal Performance 3	Vocal Performance 4
Guitar Lessons	Guitar Lessons 1	Guitar Lessons 2	Guitar Lessons 3	Guitar Lessons 4
Piano Lessons	Piano Lessons 1	Piano Lessons 2	Piano Lessons 3	Piano Lessons 4
Theater Acting/Drama	Theater Acting/Drama 1	Theater Acting/Drama 2	Theater Acting/Drama 3	Theater Acting/Drama 4
Dance Lessons	Dance Lessons 1	Dance Lessons 2	Dance Lessons 3	Dance Lessons 4
Golf Lessons	Golf Lessons 1	Golf Lessons 2	Golf Lessons 3	Golf Lessons 4
Tennis Lessons	Tennis Lessons 1	Tennis Lessons 2	Tennis Lessons 3	Tennis Lessons 4
Basketball Skills Lessons	Basketball Skills Lessons 1	Basketball Skills Lessons 2	Basketball Skills Lessons 3	Basketball Skills Lessons 4
Batting Lessons	Batting Lessons 1	Batting Lessons 2	Batting Lessons 3	Batting Lessons 4
Sports Performance Training	Sports Performance Training 1	Sports Performance Training 2	Sports Performance Training 3	Sports Performance Training 4
Speed & Agility Training	Speed & Agility Training 1	Speed & Agility Training 2	Speed & Agility Training 3	Speed & Agility Training 4
Swimming	Swimming 1	Swimming 2	Swimming 3	Swimming 4

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* 3. Which days work the best for your family to participate in activities?
(Check all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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* 4. Preferred time for activities

Morning (9a-12p)

Afternoon (12-3p)

Late Afternoon (3-6p)

Evening (6-8p)

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* 5. Are there any other activities you would like to see offered at Joint Base Charleston Weapons Station for youth?

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* 6. Additional comments or concerns