Program Feedback Form

Thank you for taking the time to provide your feedback on our programs. We appreciate your input into the WISE Mobile Active Living Centre.

Which program did you attend? (please note you can select one program per form)

Please name or specify the program topic, workshop, or special event you attended

What was your overall level of satisfaction with the program?

Very satisfied

Satisfied

Neutral

Somewhat satisfied

Not satisfied

The program was informative, educational and relevant to the topic

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

The program offered enough time to cover the topic, information or physical activity

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

The facilitator was thorough at covering the topic, information or physical activity

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Feedback/Comments

Our Program Feedback Form is anonymous, please provide your contact details (name and telephone number) if you would like one of our staff to follow up with you directly.

I consent to my feedback, comments, or quotes to be used for marketing purposes such as newsletters, media releases, and/or articles for publication. (Please note if you have provided your name above, it will not be included in our marketing content).

I consent

I do not consent

Today's Date

This information is collected in a safe and secure manner and is collected in accordance with s.29(2) of the Municipal Freedom of Information and Protection of Privacy Act.

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Program Feedback Form