Deaf Kids/Teens Club
Activities Survey

Time Period Participated From July 2007 to December 2007

(To see which activities your child had participated in,
check the DKTC Past Activities/Pictures page.)

DKTC Participant Name: _________________________________  Age: ______
(Must have name in order to receive a $5.00 gift card)

Parent(s) Name: ___________________________________ (optional)

Person completing this form:   Parent ____    DKTC Participant ____    Both ____

How often did you (your child) participate in DKTC activities between June 2007 and December 2007?
                ____ 1 - 3       ____ 4 - 7       ____ 8 - 10       ____ more than 10

Which activities were most helpful to you (your child)?

What did you (your child) like about these activities?

What activities were least helpful to you (your child)?

What did you (your child) not like about those activities?

Please rate your (his/her) overall satisfaction with DSC sponsored activities.
      5            4            3            2            1                5 = great    |    3 = okay    |    1 = poor

Please give your suggestion for program improvement & future activities below.