Parent Information

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* 1. Name:

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* 2. Email address:

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* 4. Which times of the week are you available to meet? (Please check all that apply.)

  Sun. Mon. Tues. Wed. Thurs. Fri. Sat.
Morning (8 AM - 12 PM)
Afternoon (12 PM - 6 PM)
Evening (6 PM - 9 PM)
Late Evening (9 PM - 11 PM)

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* 5. Would you be interested in attending online/video conference parent wellness circles? 

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* 6. Would you be willing to lead small parent wellness circles after a brief training?

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* 7. Please indicate any special interests or topics you would like to discuss in your parent wellness circles.

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* 8. What ages are your children?

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* 9. Questions/Comments: 

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