This form is intended for organizations that operate, or wish to operate, after-school and/or summer camp programs.
* Required Field
* First Name:
* Last Name:
Title:
* Organization:
* Street 1:
Street 2:
* City:
* County:
* State/Province:
* Zip:
* Work Phone:
(555-555-5555)
Fax:
* Email:
* Confirm Email:
* 1. Do you have an existing after-school or summer camp program?
Yes No
* 2. How many children between the ages of 5 and 14 attend your program? (Estimate)
* 3. Is there a physical activity component to your current program?
3b. If Yes, How many of the kids in your program ages 5 to 14 participate in the physical activity portion?
All (100%) of the kids participate About 75% participate About 50% participate About 25% participate Fewer than 25% of the kids participate
* 4. Do you have access to an indoor or outdoor recreational area to accommodate activities?
