Please complete this survey (one per household) for the 2022-2023 school year.

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* 1. Parent Name(s)

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* 2. Parent Email Address(es)

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* 3. Parent Phone Number(s)

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* 4. Youth Name

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* 5. Youth Age & Grade

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* 6. Youth Name (2)

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* 7. Youth (2) Age & Grade

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* 8. Youth Name (3)

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* 9. Youth (3) Age & Grade

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* 10. Questions / Concerns (optional)

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