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Wayne Y ECLC November Open House Registration
Please complete this brief 2 minute survey.
Parent Name *
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Parent Email *
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Parent Cell Phone Number *
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Parent's Place of Employment *
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Town *
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Please select the program choice you are interested in. *
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Child's Full Name *
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Child's Date of Birth *
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Child's Name (2)
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Child's Date of Birth (2)
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Child's Name (3)
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Child's Date of Birth (3)
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How did you hear about the Wayne Y ECLC? *
Are you aware that the YMCA is open to all and financial assistance is made available to all families?
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