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Park Name*
Bear Creek Lake State ParkBelle Isle State ParkBreaks Interstate ParkCaledon State ParkChippokes Plantation State ParkClaytor Lake State ParkDouthat State ParkFairy Stone State ParkFalse Cape State ParkFirst Landing State ParkGrayson Highlands State ParkHigh Bridge Trail State ParkHolliday Lake State ParkHungry Mother State ParkJames River State ParkKiptopeke State ParkLake Anna State ParkLeesylvania State ParkMason Neck State ParkNatural Bridge State ParkNatural Tunnel State ParkNew River Trail State ParkOcconeechee State ParkPocahontas State ParkPowhatan State ParkSailor's Creek Battlefield State ParkSeven Bends State ParkShenandoah River State ParkShot Tower State ParkSky Meadows State ParkSmith Mountain Lake State ParkSouthwest Virginia MuseumStaunton River Battlefield State ParkStaunton River State ParkTwin Lakes State ParkWestmoreland State ParkWidewater State ParkWilderness Road State ParkYork River State Park
Date of visit*

Number of Nights Stayed*
0 (Did not stay overnight) 1 2 3 4 5 6 7 8 9 10 11 12 13 14

How would you rate your visit to this park overall?

Excellent Good Average Poor Unacceptable N/A
Natural / Historic Resources
Activities and Programs
Fees
Facilities / Parking / Grounds
Facility Cleanliness
Staff Assistance
Security
Brochures / Info / Signs / Web

How would you rate facilities and services that applied to your visit?

Excellent Good Average Poor Unacceptable Not Offered,
But I would like to
See it added to this park

N/A
Trails
Picnic Areas
Beach / Swimming
Boat Launch Facilities
Watercraft Rentals
Playgrounds
Food Services
Visitor Center
Restrooms
Nature Programs
Cultural / Historical Programs
Educational Programs
Gifts and Souvenirs
Shelter Reservations
Park Signage
Disabled Access

Cabin Stay: Cabin #

Would like to see added

Excellent Good Average Poor Unacceptable N/A
Furnishings
Appliances
Comfort Level
Cleanliness
Check In / Check Out
Reservations

Camping: Site #

Campground:

Would like to see added

Excellent Good Average Poor Unacceptable N/A
Campsites
Bathhouse(s)
Hookups
Check In / Check Out
Reservations

Which of the following activities did you participate in while visiting this park?*

Fishing

Camping

Hiking

Picnicking

Swimming

Boating

Bicycling

Horseback Riding

Educational Activities

Nature Observation

Special Event

Visiting / Touring

Cabin / Lodge Stay

Nature Programs

Other

Which information source(s) influenced your decision for this visit (select all that apply)?

Brochure or Travel Guide

Facebook

Magazine Ad

Memory of past visit(s)

Newspaper Ad

Radio Ad

Road Sign/Billboard

Television Ad

Tourism Information Center

TripAdvisor

Twitter

Website

Word-of-Mouth/Recommendation

Yelp

You Tube

Instagram

Pandora/Streaming Radio

Pinterest

Vehicle Ad/Bus Wrap

Social Media--Sponsored Posts

Park Guide

Newspaper/Magazine Article

Blogger

Newsletter

Number of people in your group?

Adults 1 *************************************************************************************************************************************100

Children 0 *************************************************************************************************************************************100

Who had the MOST influence in deciding to visit this park for this visit?*
You Your husband or male significant other Your wife or female significant other Extended family member, female (mother, grandmother, aunt, etc.) Extended family member, male (father, grandfather, uncle, etc.) Child/Children Friend(s) who live with you (female) Friend(s) who live with you (male) Someone in the group outside of your household/family (female) Someone in the group outside of your household/family (male)

One way distance from your home to this park? (miles)*

State you live in*