Parents, please fill out this section and return it to one of the instructors. From this section, we hope to learn what you as a parent expect from the program and how we can help you accomplish your goals.

What was your initial motivation to start your child in Aikido, or what triggered you to think about a martial arts program? (Please check as many as apply)

O recommendation from a friend
O recommendation from a teacher
O recommendation from a professional (counselor, doctor, etc.)
O cut-back in phys-ed in school
O need to find a hobby /activity
O desire to do something with a friend
O meet new friends
O find a way to boost self-confidence
O help your child protect him or herself
O your own interest in the sport
O other: (please specify) __________________________

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How did you learn about Methuen Aikido?

O drove by on Parkhurst Road
O heard about it from a friend
O looked into the yellow pages
O our website: www.northeastaikikai.com
O found listing in a magazine
O other: (please specify) _______________

What do you hope your child will learn from the Children's Aikido program?

(Please indicate top 3)

O Aikido techniques
O discipline
O self-discipline
O respect for others
O general physical coordination
O general strengthening and endurance
O Japanese culture
O increased self-confidence
O self-defense
O meditation
O flexibility
O increased awareness of surroundings

What do you hope your child will learn from the Children's Aikido program?

(in your own words)

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Please return the questionnaire to an instructor. Thank you.