Parent/Guardian First Name *
Parent/Guardian Last Name *
Child First Name *
Child Last Name *
Email *
Mobile *
How did you learn about the event? *
Flyer (school, church, organization, etc.)
Facebook
Google Ad
A friend told me
my general dentist
Newspaper article
TV/Radio
SCL Newsletter
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What is your household size? *
2
3
4
5
6
More than 6
What is is your household taxable income? *
$40,599 or less
$40,600 - $51,049
$51,050 - $61,499
$61,500 - $71,949
$71,950 - $82,399
More than $82,400
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