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* 1. Child’s name:

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* 2. Date of Birth:

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* 3. What childcare, kindergarten or school does your child attend?

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* 4. What grade is your child in?

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* 5. Does your child have any health/medical conditions that we should be aware of? 

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* 6. Is your child on any medication that we should be aware of?

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* 7. Does your child have any allergies and/or dietary requirements?

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* 8. What are you and/or your child looking to get out of Kids Yoga at Tidal Flow? Select all that apply.

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* 9. Parent(s) name(s), email address and best contact phone number:

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* 10. How did you hear about us?

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