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* 1. Child(ren)’s Name(s):

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* 2. Child(ren)’s Birthday:

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* 3. Age(s):

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* 4. Parent/Guardian Name(s):

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* 5. Parent/Guardian Email:

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* 6. Parent/Guardian Phone Number:

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* 7. Your Mailing Address:

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* 8. I am interested in learning more about the following programs:

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* 9. How did you hear about us?

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