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1
Child Details
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First Name
Last Name
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2
Parent Name
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First Name
Last Name
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3
Parent Phone Number
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Please enter a valid phone number.
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4
Parent Email Address
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example@example.com
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5
Child Age
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6
Is your child Currently Enrolled in Mardyke Arena Swimming Lessons?
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YES
NO
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7
Which level does your Child currently attend?
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Level 1
Level 2
Level 3
Level 4
Level 5
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8
If your child attends lessons elsewhere, please specify where and which level they attend?
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