Wufoo

Gifted Child Survey

We are gathering information about the gifted children and their adults who are interested in participating in Northwest Florida Mensa's Gifted Child activities.

Our goal is to create and foster activities for gifted children under 18. If you have children who would like to meet more of their peers, please fill out this survey so that we can plan activities that will best meet your needs.

The gifted child events will be open to any child who is a member, or a relative of a member--child, grandchild, niece, nephew, etc--or any other child who is a guest of a member.

All information will be kept confidential.

Thank you,
Jill and Debi

Adult's Information

Please give us your contact information so that we can keep you informed with emails and letters.
Adult's Name First Last
Email

We will only use your email address to inform you of upcoming events. It will not be shared with anyone.
Children's Information
Number of Children

Let us know the number of children you have who may be participating in Gifted Child Program activities.
Age of child(ren)
Birth to 4 years 4 years to 7 years 7 years to 12 years 13 years to 17 years

Select as many as apply.
Activities
I would be willing to attend events in or near:
Pensacola Panama City Niceville Destin Fort Walton Beach/Shalimar/Mary Esther Gulf Breeze/Navarre

How far are you willing to go? Of course, we know you'd like to attend events close to home, but let us know how far you are willing to travel for occasional events. Select as many as apply.
I would like to attend these types of events:
Lunch/Dinner/Picnic Science center/Museum Zoo/Nature Walk Bowling/Mini golf Game day Science-related activities Movie theater Information session for parents about gifted issues

Select as many as apply.
Suggestions for other events or locations?
Do Not Fill This Out
Do Not Fill This Out