First, which facility(ies) and/or program(s) do you wish to comment upon?
Facility(ies) Program(s)
1. Have you ever participated in any of our program(s) before?
Yes No
2. Are you a Wethersfield resident?
Yes No
If not, what town?
3. How did you find out about the program(s)?
Newspaper
Flyers
Contacting Office
Department Brochure
Word of Mouth
Web Site
Other
4. Which categories most influenced your decision to participate in the program(s)? (May select more than one.)
Convenient time
Instructor
Reputation of classes
Not offered elsewhere
Quality of facility
Good value for the money
Other
5. How did we do? Please rate the following.
6. Would you re-register for the program(s) based on your experience?
Yes No
7. Would you recommend the program(s) based on your experience?
Yes No
8. What did you particularly like about the program(s). Please specify program(s).
9. What other program(s) would you would like to see offered?
10. What changes would you like to see made? Please specify program(s).
11. Would you be willing to pay more for programs if price hikes were necessary due to increased service costs?
Yes No
12. If yes, how much of an increase would you be willing to pay? Please specify program.
13. Do you have Internet service?
Yes No
14. If yes, do you visit the Town web site?
Town Government Information Recreation Information Both
15. What additional information would you like to see presented on the town web site pertaining to government information or recreation programs/facilities?
16. Would you like to see more town maps on the web site? If so, what kind of information would you like shown?
17. Age and gender of participant(s). Please select age and gender of each participant.
Age... <1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Gender... Male Female
Age... <1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Gender... Male Female
Age... <1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Gender... Male Female
Age... <1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Gender... Male Female
Age... <1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Gender... Male Female
Age... <1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Gender... Male Female
The following questions are optional. However, they will help us in future planning to identify users' needs.
18: Family Income:
Select...
Less than $10,000
$10,001 - $20,000
$20,001 - $40,000
$40,001 - $60,000
$60,001 - $80,000
Greater than $80,000
19. Would you like a member of the staff to contact you?
Yes No
Name
Telephone Number
E-Mail Address