Athletic Assessment for Choctaw County and Surrounding Areas
Athletic Assessment
We ask that you complete this survey for each child that you have, that could benefit from athletics outside of their school. We are asking for ALL AGES K-12
Child's Age Range
Please Select
6 and Under
8 and Under
10 and Under
12 and Under
14 and Under
16 and Under
18 and Under
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
-
Month
-
Day
Year
Date
Is your child currently active in any sports
Yes
No
Does your child have anywhere to train other than regular practice?
Yes
No
Do you feel that there is a need for a local athletic training facility?
Yes
No
Is your child at risk for obesity?
Yes
No
Does your child have diabetes?
Yes
No
Is your child at risk for diabetes or has anyone in your child's immediate family been diagnosed with diabetes?
Yes
No
Does your child struggle with behavioral problems at home or school?
Yes
No
Does your child struggle with their mental health?
Yes
No
Does your child currently have access to additional athletic resources in your area outside of school: such as media training, camps, tutoring, personal training, and case management?
Yes
No
Would your child benefit from these services?
Yes
No
Submit
Should be Empty: