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First Name

Last Name

Organization

Email Address

Group Name

Number of Participants

Price/Budget (not required)

First Potential Date

Second Potential Date

Third Potential Date

Do you have any specific scheduling needs? (morning, afternoon, evening, weekend)

What is your preferred event duration?

Where would you like your event to be located?

Please select any areas you'd like us to focus on with your group. (If you are interested in facility rental only, please select N/A):

Please select the activity or activities that your group would like to participate in

Icebreakers/energizers
Initiative/team-building activities
Portable low ropes activities (activities that require support)
High ropes course
Climbing wall
Facility rental only

Has this group done team-building/retreat type activities in the past, outside of the BRIDGES Center?

Describe the group that will be coming to Team BRIDGES

Is there anything else that is significant about this group that will assist us in planning?

What is your ultimate goal for this group?

Team BRIDGES can often make adaptations to activities to include all participants. Are there any circumstances that may hinder or prevent individuals from fully participating (i.e., physical, mental, emotional)?

If yes, please describe

How did you hear about us?

Needs Assessment

Needs Assessment Form 22-23

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