Escape Alive Survival Skills
Follow-Up Survey
Name
First Name
Last Name
Email
*
example@example.com
Location and date of class you attended
*
Please Select
Unionville - 1/31/26
Cheshire - 2/22/26
Naugatuck - 3/29/26
Oxford - 4/19/26
Winsted - 5/9/26
Northford - 6/20/26
Old Saybrook - 7/19/26
How did you hear about the class?
*
Company/Sponsor
Enewsletter
Flyer
Friend/Family
Host/Venue
Online Search
Past Participant
Social Media
Website
Other
Name of company/sponsor
*
Name of friend/family member
*
First Name
Last Name
Opinion rating
*
Rows
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
The class increased my confidence in my ability to protect myself.
The class improved my awareness of my surroundings and potential safety risks.
The class helped me better recognize unsafe situations before they escalate.
I learned verbal strategies I can use to set boundaries or de-escalate a potentially unsafe situation.
I feel more prepared to use physical self-defense techniques, including striking skills, to escape if necessary.
The class increased my understanding of both verbal and physical prevention strategies for personal safety.
Which of these skills do you feel more confident using after this class? (Select all that apply)
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Being aware of my surroundings and spotting potential risks
Saying “no” or setting verbal boundaries
Using verbal de-escalation strategies
Using physical self-defense techniques (e.g., striking skills)
Knowing when to seek help from a trusted adult or resource
Which of these actions would you feel ready to do if you needed to stay safe? (Select all that apply)
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Move away or escape from a situation
Use a verbal strategy to set boundaries or de-escalate
Use physical self-defense if necessary
Ask for help from a trusted adult or resource
What is the most important thing you learned in this class that will help you stay safe?
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Would you take this class again?
Yes
No
Not sure
To ensure we deliver the best experience possible, please leave any additional comments you may have.
May we use your comments on our website and promotional material?
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