Department/Area:

Date:    Time:

To help the YMCA serve you better, please take a few minutes to grade us on the following.

Please rank the following on a 1-5 scale

5 - excellent
4 - very good
3 - good
2 - fair
1 - poor

Cleanliness and appearance of YMCA facilities	1     2     3     4     5
Staff friendliness	1     2     3     4     5
Staff knowledge	1     2     3     4     5
Equipment maintenance	1     2     3     4     5
Equipment availability	1     2     3     4     5
Quality of classes	1     2     3     4     5
Convenience of schedule	1     2     3     4     5

Has any staff member learned your name?	Yes     No
Are you properly greeted when entering the facility?	Yes     No
Does staff take the initiative to talk to you?	Yes     No
Have you been made to feel welcome?	Yes     No

On a scale of 1 to 10 (10 being most positive), how would you rate your YMCA experience?
Please select 10 9 8 7 6 5 4 3 2 1

Optional Information

What can our YMCA do to improve your experience with us?

Other comments or concerns:

Name:

Phone: (H)    (W)

Should we call you? Yes    No

Please press the Submit button below to complete the survey.