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* 1. What is your child's name?

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* 2. How old is your child?

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* 3. Classes will most likely be a one hour lesson, once a week, after school (5pm) or weekends - what day/s best suit your child's availability (please select all available days)?

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* 4. What is your child interested in?

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* 5. Please provide your contact details:

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* 6. Comments or questions:

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