Name:

Email:  (required)

Phone Number:

Type of Program:

Birthday Party      Workshop  Assembly/Show  

After School Program   Off Track Camp  

Parks & Recreation Program Summer Camp

"Fun Station" Promo Booth

Other

Date of activity:

Location of activity:

Mad Scientist (instructor):

Please rate the following as: poor, fair, good, very good or excellent 

Instructor

• Promptness                            P   F   G  VG E
• Professionalism/Appearance  P  F  G VG  E 
• Control of Children                 P  F  G VG  E 
• Enthusiasm/Energy level         P  F  G VG  E 
• Knowledge of Content            P  F  G VG  E   

Program

• Age Appropriateness               P  F  G VG  E
• Held children's interest           P  F  G VG  E  
• Overall value                          P  F  G VG  E
• Take Homes N/A                P  F  G VG  E
• Goody Bags N/A                P  F  G VG  E

May we use you as a reference?      YES   NO
Would you recommend Mad Science to others?  YES   NO