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
Other
What is your household size? *
2
3
4
5
6
More than 6
What is is your household taxable income? *
$48,720 or less
$48,721 - $61,260
$61,261 - $73,800
$73,801 - $86,340
$86,341 - $98,880
More than $98,881
Submit
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