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

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

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

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

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

* 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.

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

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

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

* 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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