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MorningsAfternoonsEvenings

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A Little Bit About Your Child & Water Confidence

Childs Full Name

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How confident are you in the water? 1 = not confident, 10 = very confident

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How confident is your child in the water? 1 = not confident, 10 = very confident

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Any additional information:

Please enter any child/parent medical issues we should be aware of

How did you hear about Little Dolphins?*

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