Danceworks Generations Survey for Senior Centers

Name of Senior Center Facility:*

Senior Center Address:*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Senior Center Phone Number:*

Primary Contact Name:*

First

Last

Primary Contact Email:*

Primary Contact Phone Number:*

Please list any dates during the timeframe desired that there will be no class? (Previously Scheduled Activity, Field Trips, etc.)*

What is the estimated number of clients/participants?*

What else would you like to share about your clients/participants?*

In order to heighten the value of the experience, Danceworks aims for the Generations program to be integrated into the day to day environment of your facility as much as possible. Are there any specific goals that you have for your group that you’d like to share? (special preferences, thematic ideas, holiday celebration ideas, etc.)*

If you selected "other" for the question above, please explain here:

What are the dimensions of the space that will host the Generations program?*

As needed, Danceworks can provide an adequate sound system for Generations programming. To help us assess whether we need to bring equipment or not, please respond to the following questions regarding your sound system availability. Do you have (please select all that apply):*

A sound system with auxiliary cord

A sound system with Bluetooth capabilities

A microphone

We don't have any of these items