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QUESTIONNAIRE


Group Information

Group Name:
Number of Participants Attending:
Age(s)/grade(s):
*If multiple ages/grades, please indicate number of students per age/grade*

Group Contact Information

School/Organization Mailing Address (please include city, state, and zip):
School/Organization Email Address:
School/Organization Phone Number (please include area code):
Preferred Method of Contact:

Primary Contact Information

Primary Contact:
Primary Contact Cell Number:
Primary Contact Daytime Phone Number:
Primary Contact Email:
Preferred Method of Contact/Best time to reach you:
Will the primary contact be attending the trip with the participants?
Additional Teachers/Chaperones:

Program Topic Interests

Please indicate your group's interest(s). These program concentrations can be infused within any type of program you choose. These can be reinforcing themes that your group would like to focus on throughout your day.
Communication
Leadership
Respect
Responsibility
Teambuilding
Other

Intensity/ Depth of Programming

Please indicate your group's interest level. Introductory programs allow participants to get a taste of a specific topic or activity. Moderate programs allow participants to gain a more in-depth programming experience. This is also helpful for those with some previous experience or knowledge. Intense programming is specifically suited for those looking for an in-depth experience and is great for those with previous knowledge or experience.
Introduction
Moderate
Intense

Length of Entire Program

Please indicate your group's interest in programming length. Are you looking for a half day of total programming or would you like to spend an entire day on our property? Would your group like to stay overnight and spent multiple days?
1-4 hours (1/2 day)
4-8 hours (full day)
2 days (1 overnight)
Multi-day and night

Program Location

Please indicate your group's interest in location of programming. Many of our programs have the ability to travel. There is no guarantee that all components of all programs have the ability to become mobile (i.e. our rockwall is not mobile).
On-site at Life Adventure Center of the Bluegrass
At your school or location
Off-site/ Customized Location (i.e. State Park), if so, where

Overnight Accommodations

Please indicate your group's interests and needs. Our education building has restrooms as well as shower facilities. Our cabins provide indoor shelter in a bunkhouse style. If your group is interested in camping, we do have an extensive selection of camping materials for rent ranging from tents and sleeping bags to cook stoves.
Our group is not interested in staying overnight
Our group is interested in staying in the cabins
Our group is interested in tent camping near the Education Building
Our group is interested in tent camping on LACBG's property (without shower facilities)
Our group is interested in camping at a National or State Park
Our group will need to rent camping gear

Program Information (please provide specific information)

Anticipated Program Date and Time (please indicate first preference and alternative dates):
Anticipated Arrival Time::
Anticipated Departure Time:

Core program area(s)

Please indicate your group's area(s) of interest. At Life Adventure Center of the Bluegrass, we have the ability to offer customized programming utilizing any or all of our core program areas including Challenge Course, Equine, Environmental Education, and Wilderness Living.
  Program Description Age Required Minimum Group Size
Challenge Course low-ropes, rockwall, high-ropes, zipline, group initiatives, teambuilding 9+ 8+ (weekday)
15+ (weekend)
Environmental Education non-formal education, curriculum-based, outdoor classroom (forestry, gardening, soils, water, wildlife, geology) Pre-K+ 10+
Equine horse care, riding, vaulting 7+ Varies with Programming
Wilderness Living outdoor and adventure education, camping, backpacking, canoeing, wilderness survival, skiing, caving, climbing 7+ 5+

Programming/Curriculum

Will these programs relate to your classroom curriculum? If so, please explain in detail so we can better customize your programming at Life Adventure Center of the Bluegrass.

Other

Please let us know of any special issues, needs, instructions, or comments. These can include but are not limited to dietary, physical, behavioral, academic, language, and medical.

Disclaimer

This group interest survey indicates interest only and is used for informational purposes only. Completing this survey does not guarantee programming. We will use this survey and your answers to create a program that best suits your group's interests/needs.