What is your full name? (First and Last name, please)

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* 1. What is your full name? (First and Last name, please)

What are the full names & ages of the children attending Boppin' Music Class with you?

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* 2. What are the full names & ages of the children attending Boppin' Music Class with you?

Which Boppin' Music Class(es) do you attend?

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* 3. Which Boppin' Music Class(es) do you attend?

What is the best phone number for you to receive text messages?

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* 4. What is the best phone number for you to receive text messages?

What is your home address or the home addresses of the children attending Boppin' Music class?

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* 5. What is your home address or the home addresses of the children attending Boppin' Music class?

If you're a childcare provider, please list the parents'/guardians' names and phone numbers of the children you bring to Boppin' Music class.

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* 6. If you're a childcare provider, please list the parents'/guardians' names and phone numbers of the children you bring to Boppin' Music class.

At what email address would you like to be contacted?

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* 7. At what email address would you like to be contacted?

Will you attend The Parent Chat Hour on Thursdays from 11:15-12:30 PM

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* 8. Will you attend The Parent Chat Hour on Thursdays from 11:15-12:30 PM

Is there a day/time for music classes you would like to see offered? If so, please list below.

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* 9. Is there a day/time for music classes you would like to see offered? If so, please list below.

Would you be interested in being enrolled in our Home Parent Coaching program?  The parent coach would visit once per week to offer support for the hardest job there is--parenting.

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* 10. Would you be interested in being enrolled in our Home Parent Coaching program?  The parent coach would visit once per week to offer support for the hardest job there is--parenting.

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