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* 1. Which of the following programs do/does your child/children attend/participate in (check all that apply)?

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* 2. In the last 12 months, what activities has your child participated in at the Lunney Youth Center (check all that apply)?

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* 3. In the last 12 months, what activities has your child participated in at the Misawa Teen Center (check all that apply)?

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* 4. Please rate your satisfaction with the ACTIVITIES at the following programs:

  1. Extremely Dissatisfied 2. Dissatisfied 3. Somewhat Dissatisfied 4. Neutral 5. Somewhat Satisfied 6. Satisfied 7. Extremely Satisfied N/A
Lunney Youth Center
Misawa Teen Center
Cheli School Age Program
Youth Sports
Yoiko Child Development Center

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* 5. Please rate your satisfaction with the STAFF at the following programs:

  1. Extremely Dissatisfied 2. Dissatisfied 3. Somewhat Dissatisfied 4. Neutral 5. Somewhat Satisfied 6. Satisfied 7. Extremely Satisfied N/A
Lunney Youth Center
Misawa Teen Center
Cheli School Age Program
Youth Sports
Yoiko Child Development Center

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* 6. Please rate your satisfaction with the HOURS at the following programs:

  1. Extremely Dissatisfied 2. Dissatisfied 3. Somewhat Dissatisfied 4. Neutral 5. Somewhat Satisfied 6. Satisfied 7. Extremely Satisfied N/A
Lunney Youth Center
Misawa Teen Center
Cheli School Age Program
Youth Sports
Yoiko Child Development Center

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* 7. Please rate your OVERALL SATISFACTION with the following programs:

  1. Extremely Dissatisfied 2. Dissatisfied 3. Somewhat Dissatisfied 4. Neutral 5. Somewhat Satisfied 6. Satisfied 7. Extremely Satisfied N/A
Lunney Youth Center
Misawa Teen Center
Cheli School Age Program
Youth Sports
Yoiko Child Development Center

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* 8. Are there other places within 100km of base you have taken your children that you feel would be good destinations for youth field trips?

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* 9. Please use the space below to provide any additional information that might be helpful to the Misawa Youth Programs, including activities your child/children currently enjoy, other activities your child/children would like to see offered, general comments about the youth programs, etc.

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* 10. Please use the space below to provide any concerns about any of the activities and/or programs that your child/children participate in.

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