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* 1. Please enter your Boys and Girls Club of Massillon Member number

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* 3. Please describe your Experience with the Kidstop Summer Program around the following statements

  Strongly Agree Agree Disagree Strongly Disagree
In this program's activities, I am given the chance to help others.
I get to help plan, choose, or lead the activities of this program.
The adults who work with this program really care about me.
The adults who work with this program listen to what I say.
The adults who work with this program make me feel like I belong.
The adults who work with this program make me feel important.
The adults who work with this program encourage me to do well in school.
The adults who work with this program challenge me to do my best.
Being involved in this program makes me want to learn more about new things.
Being involved in this program has taught me rules about what is okay to do and what isn't.
Being involved in this program has made me want to try harder in school.
This program has helped me make better decisions.
This program has helped me realize I have a lot to be proud of.
This program has helped me get along with others.
This program has helped me learn I can do things I didn't think I could do.
This program has helped me make friends and keep friends.
This program has helped me feel successful in the activities I've been a part of.
Since I have been involved in this program respecting other people's feelings and property has become more important to me.
Since I have been involved in this program caring about other people has become more important to me.
Since I have been involved in this program being responsible for what I do has become more important to me.

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* 4. Please tell us about your favorite activity at the Boys and Girls Club this summer and why?

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* 5. Any thing else you would like to tell us about...

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* 6. Please list program ideas or activities you would like to try or see the Boys and Girls Club add to our programming?

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