Heartland Center Adventure Activities - Needs Assessment

Name of Group/Organization:

Date and Time of Event:

Course (please circle): Summit (high course) Edge (low challenge) GPS CLiip

Contact Person: Phone and E-mail:

# of participants: Age range of participants:

Are there any participants with special needs? Yes/No If yes, please explain below:

What is the main purpose of the group participating in Heartland Adventures?

Do you have specific objectives or issues you wish to have addressed? (i.e.: cooperation,

trust, peer respect, group focus, leadership, spirituality)

What would you like to take from your experience, or what changes if any, would you like to

see in the group from their experiential learning experience?

Any additional information you feel would help us in planning the best possible program and

experience for your group:

Thank You!

*Please remember to bring signed Release of Liability and Health forms for each participant and for them to wear

sturdy, fully enclosed shoes