Youth Safety Evaluation Form
Club Name ________________________________________ Club Number __________________
Title of activity ____________________________________________________________________
Summary of activities ______________________________________________________________
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Number of Club Members involved ___________ Number of people attended _____________
Number of people reached _________________________________________________________
Please check any other organizations that worked with your Club(s) on the project:
School Youth Group Civic/Volunteer Group Community Center
Local Business Government Office
Cost of sponsoring this activity _____________________________________________________
Did you secure any type of sponsorship? Yes No
Publicity received (check all that apply): Newspaper Bulletin Newsletter Radio
Did you recruit new Members from this activity? Yes No
Will your Club conduct this activity again? ____________________________________________
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What recommendations would you make for improving this activity? ____________________
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Thank you for taking the time to complete this valuable form.
Mail to: Optimist International, c/o Programs Department, 4494 Lindell Blvd, St. Louis, MO. 63108
Fax to: (314) 371-6006
E-Mail: programs@optimist.org