Healing in the Outdoors Community Wellness Day Survey
Answer a few questions about your experience today and share contact info only if you want updates.
About You
Age
*
Under 10
10–12
13–15
16–18
19 or older
Prefer not to answer
Identity
*
Black or African American
Hispanic or Latino
White
Asian or Pacific Islander
Native American or Indigenous
Multiracial
Another identity
Prefer not to answer
About Your Experience
Which wellness stations would you like to participate in today? (Pick 4)
*
🌿 Breathe & Bloom Yoga
🧠 Release & Reset
🧘🏾 Peace Within Meditation Lounge
💥 Rage Out Zone
🥋 Rhythm & Flow Capoeira
🍎 Brain Fuel Café
🥾 Nature's Path Adventure
🎨 Colors of Healing Studio
How do you feel after participating in today's event?
*
Much better than when I arrived
A little better than when I arrived
About the same
I'm not sure
Worse than when I arrived
About Your Family
Your answer helps us better understand the experiences of the youth and families we serve. You may skip this question if you prefer.
Has there ever been a time you were separated from a parent, caregiver, or another important family member for a long time?
Yes
No
Prefer not to answer
What was the main reason for the separation?
Family changes (such as separation, divorce, or custody changes)
A legal or court-related situation
Alcohol or drug-related challenges
Family violence or safety concerns
Illness or medical treatment
Work, military service, or living somewhere else
Death of a loved one
I'm not sure
Prefer not to answer
Another reason
If yes, what are some things that helped you during that time or what are some things that could have helped?
Staying Connected
Would you like to hear about future free events for youth and families?
*
Yes, please contact me.
No, thank you.
If you are under 18, please provide a parent or guardian's contact information.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Which opportunities would you like to learn more about?
Back-to-School Wellness Event
Free STEM training for youth in grades 6–12 (in partnership with Maydm)
Future wellness events with Seein' Is Believin'
Volunteer opportunities
None of the above
Submit
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