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1. First Name (Required.)

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2. Last Name (Required.)

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3. Email (Required.)

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4. Zip/Postal Code (Required.)

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5. I speak to my child's teacher several times a year (Required.)

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6. I attend school events like Meet the Teacher, Open House and Curriculum Fairs (Required.)

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7. I am an active participant in PTA/PTSA/PTO or equivalent parent association (Required.)

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8. I attend athletic or social events that are important to my child's school and to my child (Required.)

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9. I know my child's friends and invite them to my home (Required.)

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10. I know the parents of my child's friends and talk to them about our children's activities, plans and events (Required.)

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11. I often participate with my child in social activities (Required.)

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12. I chaperone my child's parties (Required.)

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13. I know or meet the chaperones at the parties my child attends (Required.)

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14. If my child's school needs a chaperone for a field trip or party, I will volunteer (Required.)

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15. My child and I attend weekly religious service together (Required.)

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16. We eat dinner together as a family at least 4 times a week (Required.)

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17. I have established family guidelines for my child's behavior (Required.)

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18. Clear guidelines are visual and posted in my home (Required.)

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19. I take inventory of my medicines a (Required.)

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