Welcome and Thank you for checking us out, read and fill out the information below. We cannot wait to get to know you and your family!

• First Name

  Last Name
  

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  Make Required
• Parent/Guardian First Name

  Parent/Guardian Last Name
  

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  Make Required
• Birthday
  

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  Make Required
• Mobile Phone
  

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• Email Address

  

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  Make Required
• Tell us a little about your child!
  

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  Make Required
• I would like my child to improve on...

  Awareness

  Focus

  Strength

  Coordination

  Listening

  Confidence

  Behaviour

  Accomplishing Tasks

  Fun

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  Make Required
  
  Map this to an SPARK field: -- do not map --Source DetailSSNSnack Notes
  
  Checkbox Items (seperated by commas)
  Item1,Item2,Item3
  
  Awareness,Focus,Strength,Coordination,Listening,Confidence,Behaviour,Accomplishing Tasks,Fun

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