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Parks & Recreation

Therapeutic Recreation Youth Survey

First Name:

Last Name:

Street Address:

City:

Zip/Postal Code:

Country:

Email Address: *This question is required. This question requires a valid email address.

Phone Number:

Ext:

Cell Number:

Would you participate in any of the following activities?

Gardening

Outdoor Education (Nature)

Jewelry Making

Social Programs

Arts and Crafts

Painting

Pottery

Recreation Activities

Fitness

If you would like to participate in an activity not listed above, please type it below.

What day of the week between works best for you to do an activity that you are interested in?

What part of the day works best for you to participate in the activity?

E-mail Disclaimer:

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.