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* 1. Name:

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* 3. Phone:

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* 4. What is the age of the child?

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* 5. What is your child's gender?

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* 6. What size clothing does your child wear and shoe/boot size?

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* 7. What kind of books interest your child?

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* 8. What is your child's favorite activity/interests?

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* 9. As the parent/guardian what does the child need the most?

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* 10. Pick up date: December 15, 2025 from 8:00am-3:30pm @ 117 FS Drive, Viroqua
(next to H&R Block, Spaeth Flooring)

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