Feedback Questionnaire

Feedback Questionnaire
Name:*

First Name Last Name
Home Address:*

Street Address

Knissah

City State

Zip Code
Phone Number:*

Area Code Phone Number
Email Address:*
What was your overall experience at the retreat?
What was the most significant part of the retreat for you and why?
Which activity/shiur/workshop did you enjoy the most? Please explain why:
Any part of the program that you would have liked to have more of?
Any additional/different programs that you would have liked to see at this retreat?
Was there anything that you would have liked to be done differently?
Would you have preferred more free time?

YesNo
General feedback:
Many participants have requested contact information for the other mothers who joined the retreat. If you would like to be included in the list please check below and fill in your information.
Would you like to be included in the list?*

YesNo
Age of Child:*
Diagnosis: (Optional)
Should be Empty: