Challenge Course Client Needs Assessment

Please take a few moments to complete this needs assessment as completely as possible. This information will allow us to customize your program to provide the best possible outcomes for your group. This information will be shared with the Lead Faciliator assigned to you program.

Program Information

Organization/Company Name

Program Type (Read Only)

Program Date (Click on Calendar Icon and Choose Your Program Date) +

Program Start Time (Read Only)

Program End Time (Read Only)

Contracted Minimum Group Size-this is the minimum group size you are financially responsible for based on your signed program agreement. We understand that the group size you told us you were planning to bring may be smaller than this number. (Read Only)

Updated minimum group size. Please note: updating this field does not modify the minimum participant number that you committed to and are financially responsible for based on your signed program agreement. *

Updated maximum group size. *

Contact Information

Booking Contact-First Name

Booking Contact-Last Name

Booking Contact-Title/Position

Booking Contact-Cell Phone Number

Booking Contact-Other Phone Number

Booking Contact Email Address *

Will the Booking Contact be present/on-site on the day of the program? *

On-site Contact-First Name *

On-site Contact-Last Name *

On-site Contact-Title/Position *

On-site Contact-Cell Phone Number * 🛈

Day of Program Contact-Other Phone Number

On-site Contact- Email Address *

Group Information

For youth programs, will other adults /chaperons expect to participate in the program?

How many other adults/chaperons will expect to participate? *

How long has the group been together?

Newest member:

Summary of group’s purpose/ type of organization: *

Background information of group members / dynamics:

Group’s strengths: *

Group’s areas of challenge: *

Goals for this team building session: *

What is your vision of success for this program? What change will have occurred that will indicate the program was successful?: *

As the group leader, do you see yourself as primarily observing or participating?

Are there any special needs of individuals or the group (i.e. health concerns, disabilities, participant fears/safety concerns) that our facilitators should be aware of? *

Is there any portion of the program that you would like to lead, (intro., specific activity, closing, etc.)?

Is there any unique programming that you had in mind such as a theme or certain elements of challenge? *

Please list any activities that you have done in the past that you would or would not like to see during your program with us.

If your program extends over lunch, can we do a staggered lunch break for your group (this helps with the program design). If not, how long of a lunch break will you need? Please take into consideration that meal & snack breaks are incorporated into your overall program time.

Would you be interested in arranging a follow-up program? (This would most likely include addressing your goals in a more in-depth manner, as well as addressing the group’s ability to transfer the learning from this initial program into their group-functioning)

Do you have a potential date in mind for a follow up program? +

Comments for a follow-up program:

FOR OFFICE USE

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