This can be filled out by the caregiver, chaperone or home lead. Please fill out to the best of your ability for each child that attended our program.

    Not very importantSomewhat importantImportantVery important

    1234567

    SicknessVacationLack of transportationNot interested in month’s activityChild didn’t feel like going

    12345+

    YesNo

    SocialLeadershipAthleticCommunicationTrustTeamworkNone

    CalmHappyExcitedContentIndifferentScaredSadNervousUpsetAngry

    CalmHappyExcitedContentIndifferentScaredSadNervousUpsetAngry

    12345678910

    YesNoMaybe

    Thank you :0)

    Serving San Diego & Orange County

    Proud ISTO Contributor Proud Member of International Surf Therapy Organization Global Contributors
    Proud Collaborator of the Institute on Violence, Abuse and Trauma Proud collaborator of the Institute on Violence, Abuse and Trauma
    Contact Us

    We're not around right now. But you can send us an email and we'll get back to you, asap.

    Not readable? Change text. captcha txt