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* 1. Parent or Guardian Contact Information

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* 2. What Age/Grade/Level is your child?

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* 3. Which of the following are you interested in? (Check all that apply)

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* 4. If interested in tutoring/supervision, how many days per week?

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* 5. What time of day do you prefer dance classes or tutoring/supervision?

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* 6. Is there any other information you can provide that will help us design a program to fit your needs?

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