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SUMMER BACKYARD PROGRAMMING INQUIRY
Thank you for your interest in backyard programming with Random Farms!
Primary Parent Name
*
First Name
*
Last Name
*
Primary Parent Email
*
Primary Parent Cell Phone Number
*
Child's Name
*
First Name
*
Last Name
*
Grade For The 21/22 School Year
*
K
1
2
3
4
5
6
7
8
9
10
11
12
What kind of schedule are you looking for?
*
1 Week Program
2 Week Program
Please check all dates you are considering
*
June 28-July 2
July 5-July 9
July 12-July 16
July 19-July 23
July 26-July 30
August 2-August 6
August 9-August 13
August 15-August 20
Please order your preference of session dates.
*
Please order your preference of session dates.
First Choice
Second Choice
Third Choice
Fourth Choice
I am unavailable for these dates.
June 28-July 9
Please order your preference of session dates.: June 28-July 9 (First Choice)
June 28-July 9 (Second Choice)
June 28-July 9 (Third Choice)
June 28-July 9 (Fourth Choice)
June 28-July 9 (I am unavailable for these dates.)
July 12-July 23
July 12-July 23 (First Choice)
July 12-July 23 (Second Choice)
July 12-July 23 (Third Choice)
July 12-July 23 (Fourth Choice)
July 12-July 23 (I am unavailable for these dates.)
July 26-August 6
July 26-August 6 (First Choice)
July 26-August 6 (Second Choice)
July 26-August 6 (Third Choice)
July 26-August 6 (Fourth Choice)
July 26-August 6 (I am unavailable for these dates.)
August 9-Augst 20
August 9-Augst 20 (First Choice)
August 9-Augst 20 (Second Choice)
August 9-Augst 20 (Third Choice)
August 9-Augst 20 (Fourth Choice)
August 9-Augst 20 (I am unavailable for these dates.)
Approx. how many children would be participating (including your child)?
*
What town will you be hosting the program in?
*
Where would you host the class? (Ex., my backyard, central lawn in our town park, etc.)
*
Anything else you'd like us to know?
*
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