Swim Empowerment Survey
This voluntary survey collects data to better serve future participants of the Stages of Freedom Swim Empowerment Program. All of your answers are completely confidential.
Your Name
*
First Name
Last Name
Child's Name (Swimmer)
*
First Name
Last Name
Child's Age
*
Your Child's Ethnicity
*
Black/African American
Cape Verdean
Native American/Indian
African
Caribbean
Latino/a/X
Other
Where did you learn of these swimming lessons?
*
Stages of Freedom Bookstore
Google/Bing/Other Search Engine
Facebook
Twitter
Instagram
Stages of Freedom e-Newsletter/Blast
Other
Month & year swim lessons were taken (exact day of month not required)
-
Month
-
Day
Year
Date
Which YMCA did the child take the swimming lessons?
*
Cranston YMCA
East Side/Mt. Hope YMCA
Kent County YMCA (Warwick)
South County YMCA (Peace Dale)
Newman YMCA (Seekonk, MA)
West Bay Family YMCA (North Kingstown)
Newport County YMCA (Middletown)
YMCA Camp Fuller (Wakefield)
Pawtucket Family Branch YMCA
Other
Did your child learn to swim well?
*
1
2
3
4
5
Not at all
Tremendously
1 is Not at all, 5 is Tremendously
How much did your child enjoy the swimming lessons?
*
1
2
3
4
5
Not at all
Tremendously
1 is Not at all, 5 is Tremendously
How many swimming lessons did your child attend?
*
1
2
3
4
5
None
All of them
1 is None, 5 is All of them
Did your participating YMCA provide you a certificate of completion for your swimming lessons?
*
Yes
No
I'm not sure
Would you recommend this program to other non-swimmers?
*
Yes
No
Please explain why you would not recommend this program to other non-swimmers.
*
Additional Comments
Please share any additional comments you have about the program
Upload a photo of your child swimming and get it featured on our website!
Browse Files
This is completely optional, and by uploading the file and checking the box below, you are giving Stages of Freedom permission to use the uploaded file of your child to display on our public website.
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of
Authorization for Stages of Freedom to use the uploaded file
*
Yes, I authorize Stages of Freedom to use the photo of my child to display publicly on their website. I understand that only the first name of my child will appear.
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