Title of program: _______________________________________________________________________
Date: ___________________________________________________________________________________
Attendance: ________________________ Children: ______________ Adults: _________________
Age range of children attending: ______________________________________________________
Total staff time required for planning and executing program: _______________________
Program costs, (specify items): ________________________________________________________
_________________________________________________________________________________________
Description of program: _______________________________________________________________
__________________________________________________________________________________________
Participant's reactions: _________________________________________________________________
How could program be improved/changed? __________________________________________
__________________________________________________________________________________________
Effectiveness of publicity: _______________________________________________________________
Other comments: _______________________________________________________________________
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