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Program Survey
Complete the following survey by November 1, 2013 then visit the Aquatic Center for your prize. You will also be eligible for the grand prize to be drawn on November 7, 2013!
Name
*
First
Last
What is your age?
*
Less than 13
13-18
19-25
26-35
36-50
Over 50
Prefer not to say
How did you hear about Kirksville's Healthy Handbook Program?
*
Newspaper
Kirksville Connection
Poster/Flyer
Friend
Facebook
Textcaster
Other
What did you like most/least about the Healthy Handbook Program?
*
Looking at your goals and points, how many weeks did you meet or exceed your point goals? How many points did you get on your best week?
*
Submit