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* 1. Contact Information:

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* 2. Indicate the grade level of your daughter(s) - Check all that apply:

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* 3. How could the Diamond Dad's Program best benefit you?  (Mark all that apply)

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* 4. Please indicate the topics of interest as a Dad (mark all that apply):

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* 5. Please indicate the types of activities and events you would be interest in experiencing with your daughter (mark all that apply)

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