Teachers Feedback & Referral Form
Please fill out the feedback form & referral to receive a FREE Session Valued at $250
Organisation Name (optional)
Name of Program
*
Please Select
School Self Defence
School Self Defence Webinar
School Kickboxing
School Kickboxing Webinar
School Boxing
School Boxing Webinar
School Karate
School Karate Webinar
School MMA
School MMA Webinar
School Personal Safety
School Personal Safety Webinar
School Group Personal Training
School Group Personal Training Webinar
School Bullying Prevention
School Bullying Prevention Webinar
Personal Training/Caregiving
Program Completion Date
-
Day
-
Month
Year
Date
Your Name
*
Your Phone Number
*
-
Area Code
Phone Number
Your Email Address
*
example@example.com
Instructor Name
*
Instructor Name
*
Please Select
Sean Bowring
Anthony Peterson
Andrew Zrajko
Rod Catterall
Steve Walker
Daniel Zrajko
Saleena Clegg
Greg Curwood
Referral Details (receive a FREE session valued at $250)
Would you mind telling others about our program if you think they might like it? If yes, could you share the contact details of one other organizations who might be interested? Thank you!
Organisation Referral
Name Referral
First Name
Last Name
Email Referral
example@example.com
Phone Number Referral
Please enter a valid phone number.
Feedback
How would you rate your overall experience with our school's program on a scale of 1 to 5, with 1 being the worst and 5 being the best?
*
5 = Excellent
4 = Very Good
3 = Good
2 = Fair
1 = Poor
Program content
Quality of the Instructor
Balance between theory/discussion and activities
Approachability of the Instructor
Delivery skills of the instructor
Overall program value to the school
What specific skills or knowledge did the students or yourself gained from the program that you found most valuable ?
*
Were there any aspects of the program that you feel could be improved or expanded upon to better prepare students or yourself ?
*
Do you feel more confident about your ability to protect yourself after completing the program?
*
Google Review - Please Click on Link Below
Before you submit, click on link below, give us a good google review and you will receive a FREE complimentary self defence session valued at $250
Click on link here
https://g.page/r/Cello5GDnw4AEAI/review
Submit
Should be Empty: