After-School Interest Form Question Title * 1. How did you hear about our Child Development Center? Email notification/flyer posting from school Sign along the side of the road Postcard in mail Other (please specify) OK Question Title * 2. What class(es) are you interested in? (Check all that apply) Life Skill Development Yoga + Mindfulness Social-Emotional Learning Learning Advancement OK Question Title * 3. What school does your child attend? OK Question Title * 4. What grade is your child in? (Select only grades of your children you are looking to have attend) Kindergarden 1st 2nd 3rd 4th 5th Other (please specify) OK Question Title * 5. What is your biggest struggle or goal for your child(ren) right now? Please explain in as much detail as possible. OK Question Title * 6. What day(s) are you looking to have your child participate in a program? Monday Tuesday Wednesday Thursday Friday Other (please specify) OK Question Title * 7. Please describe your family so that I may have some background information. OK Question Title * 8. Please enter your contact information. Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK DONE