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The Adventures Club: A MAD Monday Original | PRE-SURVEY

Youth are asked to complete this short pre-registration survey. At the end of the six weeks, we’ll ask you to complete a similar survey to compare how you’re feeling at the end of the program for evaluation purposes.

This field is for validation purposes and should be left unchanged.
Name(Required)
This program is open to youth ages 12 – 17. What is your current age?(Required)

Tell us How You're Doing

On a scale of 1 to 5 (not true – totally true), please tell us how you’re doing right now by answering the following questions:
My mental health negatively affects my life at HOME.(Required)
My mental health negatively affects my life at SCHOOL.(Required)
My relationship with my FAMILY is often unstable.(Required)
My relationship with my FRIENDS is often unstable.(Required)
I have trouble making connections with other people.(Required)
I have trouble making decisions.(Required)
I have trouble regulating my emotions.(Required)
I have trouble working with others.(Required)
I have trouble speaking up for myself.(Required)
I am afraid of making a mistake.(Required)
I am afraid of making a fool out of myself.(Required)
Youth who can attend all 6 weeks will be chosen first. How much do you think you can attend?(Required)