Hornell YMCA

1. What Is Your Age?

   	Under 20	21-30
   	31-40	41-50
   	51-60	Over 60

2. What Is Your Gender? (circle one)

   Male

   Female

3. How many miles do you typically travel to get to the YMCA?

   	less than 1	6-10 miles
   	1-2 miles	11-20 miles
   	3-5 miles	more than 20

4. Are you a member? (circle one)

   	Yes	No

5. What are your main reasons for attending the YMCA? (circle all that apply)

   	Exercise	Fitness Programs
   	Health Related Issues	Aquatics Programs
   	Childcare Programs	Aerobic Programs
   	Social Contact	Other - Please explain

6. What day(s) do you visit the YMCA? (circle all the apply)

   	Sunday	Monday
   	Tuesday	Wednesday
   	Thursday	Friday
   	Saturday	Varies from week to week

7. Are you familiar with the following fitness programs?
   
   

   	Familiar	Currently Use	Not Familiar
   Buff brides/Great grooms
   Cardiac Rehab
   Get Fit, Stay Fit
   Kickboxing
   Line Dancing
   Lunch Crunch
   Personal training
   Pilates
   Tai Chi Beginners
   Silver Sneakers
   Tai Chi Advanced

8. What other programs/classes would you like to see offered?

    

9. How would you rate the Hornell YMCA on each of the following?

   	Excellent	Good	Fair	Poor	Don't Know	Not Applicable
   Staff Members
   Friendliness
   Competence/Knowledge
   Availability of Staff to help you
   Greeting upon entering the YMCA
   Program or class registration
   Facilities
   Lobby Cleanliness
   Locker Room
   Security and Safety
   Adequate parking
   Adequate lockers
   Availability of pool
   Equipment
   Availability of fitness center and free weight room
   Maintenance of this equipment
   Availability of the right type of equipment
   Enough equipment to service all members
   General
   Convenience of facility hours
   Value for the money
   Quality of land aerobics classes
   Quality of aqua aerobics classes
   Quality of fitness programs

10. Please rate your satisfaction with each of the following:

    	Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied	Not Important	Don't Know
    YMCA Values
    You feel welcome at our Y
    The Y is children oriented
    The Y is helping to build a stronger community
    The Y serves people unable to pay full fee
    Treated with respect at the Y

11. What additional comments do you have that would help the YMCA staff make your YMCA experience better?

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