Evaluation Form Participant(s) Information Name(s) (optional) Age(s) Level of Play Please Select Level of PlayA-TravelB-TravelC-TravelTier - AATier - AAAHouse LeagueGirls - TravelGirls - HouseHigh Sch. VarsityHigh Sch. JVAdult NoviceAdult IntermediateAdult AdvancedOther Age Division (at time of program) Please Select Age DivisionMiteSquirtPeeweeBantamMidgetHighschoolAdultOther Hockey Association Ice Rink where you skated in Robby Glantz Program Had you/your skater attended a Robby Glantz Program before? Please SelectYes, 1 timeYes, 2 timesYes, 3 timesYes, 4 or more timesNo, never attendedNot Sure Did our Program meet your expectations? (No Response)ExceededYesSomewhatNo Comments Did you or your skater improve at our program? (No Response)YesYes, but still a long way to goNo Please list the improvements you hoped to gain from our Program. What aspects of our Program appealed to you the most? What aspects of our Program appealed to you the least? Was our program well organized and did it follow a logical order? (No Response)YesSomewhatNo Comments What other information or skills would you want us to teach? Would you enroll in our Program again and/or recommend us to a friend/teammate? (No Response)YesNo Comments Did the head instructors motivate and lead effectively? (No Response)ExcellentVery GoodGoodFairPoor Comments Did the head instructors appear cooperative and open to suggestions? (No Response)ExcellentVery GoodGoodFairPoor Comments Were the head instructors sufficiently qualified and knowledgeable? (No Response)ExcellentVery GoodGoodFairPoor Comments Are you interested in helping get the word out for us as a Local Contact and/or Group Discount Coordinator? Great Perks and benefits!! (No Response)YesNo Please send me the following number of brochures to distribute in my area: Do not send any brochures10 Brochures25 Brochures40 Brochures75 Brochures100 Brochures150 Brochures250 Brochures500 Brochures750 Brochures or more Please send me the following number of brochures to distribute in my area: Do not send any posters2 Posters4 Posters6 Posters8 Posters10 Posters12 Posters or more First & Last Name (include spouse's name if applicable) Email Address Cell Phone Mom Cell Phone Dad Your Child's Name(s) and Age(s) You or Your Child's Hockey Association You or Your Child's Hockey Association Website Potential Cities and/or Ice Arenas to host our Program? Are you interested in helping arrange a new Robby Glantz Program in your area? We run over 50 of these type programs yearly... usually in Fall or Winter and hosted by an association or rink... great fundraiser and benefits for your club!!! (No Response)YesNo Questions/comments and/or other people for us to contact: Additional Comments
