1

Date of Visit

 *

Date of Visit

2

Name of Facility

Name of Facility(Select an Answer) Marshall Community Center Northern Fauquier Community Park Warrenton Community Center C.M. Crockett Park Monroe Park Marshall Community Center Park Riverside Preserve Upperville Park Vint Hill Farms Park Larry Weeks Community Pool C. M. Bradley Elementary Fields P.B. Smith Elementary Fields W.C. Taylor Middle School Fields Warrenton Middle School Field Auburn Middle School Fields C. Hunter Ritchie Elementary Fields Greenville Elementary Fields Claude Thompson Elementary Coleman Elementary Fields Marshall Middle School Fields Cedar Lee Middle School Fields Grace Miller Elementary Fields H.M. Pearson Elementary Fields M.M. Pierce Elementary Fields Mary Walter Elementary Fields Southeastern Alternative School Fields Theater on the Green Cedar Run Greenway Rady Park Connector Warrenton Branch Greenway Whippoorwill Greenway Vint Hill Farms Greenway Lucky Hill Greenway

3

Name of program or event

Name of program or event

Rate the facility: (1 to 5 with 5 being the highest rating)

4

Cleanliness

Cleanliness

1

2

3

4

5

5

Safety

Safety

1

2

3

4

5

6

Fees

Fees

1

2

3

4

5

7

Overall

Overall

1

2

3

4

5

Rate the staff/instructor: (1 to 5 with 5 being the highest rating)

8

Availability

Availability

1

2

3

4

5

9

Knowledge

Knowledge

1

2

3

4

5

10

Overall

Overall

1

2

3

4

5

11

Name of staff you interacted with

Name of staff you interacted with

12

How did you hear about us?

How did you hear about us?

Good Times

Website

Facebook

Flyer

Department Mailing

Word of Mouth

13

What other programs/services would you like to see offered?

What other programs/services would you like to see offered?

14

Comments:

Comments:

15

Name and Phone Number (Optional)

Name and Phone Number (Optional)

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2. Email Address

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