Your Name (optional):       

Program Information:
Clubhouse Location::                  Country Meadows Ivy Hall Kildeer Kilmer Longfellow Prairie Tripp Pritchett         

How many children do you have enrolled in the program?     1 2 3 4 More than four

Grade your children are currently enrolled in? (check all that apply)      
     Kindergarten
     First Grade 
     Second Grade
     Third Grade
     Fourth Grade
     Fifth Grade

Type of service utilized?    before and/or after school care fieldtrips only both

Number of days per week your child(ren) attend?  two three four five

Service used:  AM only PM only AM & PM Not Applicable

Please rate the following:

    Staff                            1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Not Applicable
    Daily Activities          1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Not Applicable
    Equipment                  1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Not Applicable
    Snacks                        1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Not Applicable
    Arts & Crafts             1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Not Applicable
    Field Trips                  1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Not Applicable
    Communication          1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Not Applicable
    Care given to your child  1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Not Applicable

Did Clubhouse meet your expectations?  Yes No

      Comments:
    

What did you like most about Clubhouse?
    

Do you have any suggestions for future fieldtrips?  Yes No

      If yes, please list:
     

Were the Clubhouse Director and/or Assistant Director able to answer your questions and/or help with any special needs?    Yes No

      Please explain:
     

How would you rate your overall Clubhouse experience?   1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Not Applicable

            Please comment on your rating:
           

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