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2. The Community Services Department strives to provide high-quality and engaging programs that reflect and enrich the lives of the Malibu community. Please complete the Program Feedback Form to assist the Department in identifying areas of strength and improvement to understand how to meet the needs of the Malibu community.
4. 1. Have you previously participated in a City of Malibu, Community Services Department program?

   1. Yes, within the past six months
   2. Yes, within the past year
   3. Yes, within the past five years
6. 2. Which program area(s) have you or someone in your household participated in with the City of Malibu, Community Services Department? Select all that apply.

   1. Afterschool Program
   2. Arts (Poetry, Exhibits, etc.)
   3. Aquatics
   4. Community Event
   5. Day Camps
   6. Enrichment Program
   7. Parent and Me Program
   8. Senior Center Program
   9. Sports Program
   10. Workshop
8. 3. Which program are you completing this feedback form for?
10. 4. How would you rate the following aspects of the program?
12. Quality of Instruction
    -- Select One --Very SatisfiedSatisfiedDissatisfiedVery Dissatisfied
13. Program Content
    -- Select One --Very SatisfiedSatisfiedDissatisfiedVery Dissatisfied
15. Length of Program
    -- Select One --Very SatisfiedSatisfiedDissatisfiedVery Dissatisfied
16. Program Facility
    -- Select One --Very SatissfiedSatisfiedDissatisfiedVery Dissatisfied
18. Price of Program
    -- Select One --Very SatisfiedSatisfiedDissatisfiedVery Dissatisfied
20. 5. How would you rate the following aspects for the instructor?
22. Engagement
    -- Select One --Very SatisfiedSatisfiedDissatisfiedVery Dissatisfied
23. Preparedness
    -- Select One --Very SatisfiedSatisfied DissatisfiedVery Dissatisfied
25. Time Management
    -- Select One --Very SatisfiedSatisfiedDissatisfiedVery Dissatisfied
26. Inclusive Learning Environment
    -- Select One --Very SatisfiedSatisfiedDissatisfiedVery Dissatisfied
28. 6. Did the program description on the flyer, website, Recreation Guide, or social media accurately describe your experience?
    -- Select One --YesNo Partially
30. 7. How likely are you to re-enroll in a program?
    -- Select One --Extremely LikelyLikelyUnlikelyExtremely Unlikely
32. 8. How likely are you to participate in another program?
    -- Select One --Extremely LikelyLikelyUnlikelyExtremely Unlikely
34. 9. How likely are you to recommend a program to friends and family?
    -- Select One --Extremely LikelyLikelyUnlikelyExtremely Unlikely
36. 10. Additional comments, questions or suggestions.
38. Would you like to be contacted regarding the feedback you have provided?
    -- Select One --YesNo
40. If yes, please fill out the information below:
42. First Name
43. Last Name
45. Email Address
46. Phone Number
48. If you are interested or know someone who might be interested in instructing a program, please visit MalibuCity.org/ContractInstructor and submit the Intent to Instruct Form. To recommend a class to add to future schedules, please visit MalibuCity.org/ProgramInterest. Contact Recreation Coordinator Adrianna Fiori with questions at AFiori@MalibuCity.org or 310-456-2489, ext. 239.
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50. 1. Receive an email copy of this form.
51. Email address

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