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First Steps In Music Survey / Interest Form
Please fill out the following form if you are interested in providing feedback and receiving information about future classes in our First Steps in Music program for young children (generally ages 3-6).
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* Indicates required question
Parent's Name
*
Your answer
Parent's Email Address
*
Your answer
Child's Name
*
Your answer
Child's Age
*
Your answer
2nd Child's Name (if applicable)
Your answer
2nd Child's Age (if applicable)
Your answer
Please mark the locations that would be most convenient for your family (you can select more than one, if applicable)
*
Southaven
Hernando
Horn Lake
Olive Branch
Senatobia
Other:
Required
Please mark the times that would be most convenient for your family.
*
9/9:30 am
10/10:30 am
11/11:30 am
1:00/1:30 pm
3:00/3:30 pm
4:00/4:30 pm
Other:
Required
How did you hear about First Steps in Music?
*
Your answer
Additional Comments
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