To fill out the survey, on your mouse click and hold the left button and select all the text between the horizontal lines. In the "file" menu of your web browser, click "print", and in the "page range" box select "selection". Then click "print".
Survey
1. What programs or services currently offered at the Amelia Community Center do you use (or have you used)? Please check all that apply.
Program Currently Use Have Used
Open Gym . . . . . . . .
Weight Room . . . . . .
Room Rental . . . . . . .
Baseball/T-ball . . . . .
Other (specify) . . . . . ( )
Other (specify) . . . . . ( )
Other (specify) . . . . . ( )
2. What programs or services would you use if offered? Please check all that apply.
_____ 3-on-3 basketball league
_____ Flag football
_____ Softball league
_____ Cooking instruction
_____ Role playing games (D&D, etc.)
_____ Tutoring
_____ Gardening
_____ Weight training
_____ Aerobics
_____ Friday Teen Night
_____ Sports clinics
_____ Other (specify): _____________________________
_____ Other (specify): _____________________________
_____ Other (specify): _____________________________
_____ Other (specify): _____________________________
3. How could we improve the Amelia Community Center facility?
Name: ____________________________ E-mail: ______________________________
Age: ____________ Phone: ____________________________
Thank you for your participation!
Please return the completed form to this address:
Amelia Community Center
Attn: Survey
P.O. Box 82
Amelia, LA 70340
