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Your Name:_____________________________ Phone:_________________________
Address:_________________________________ e-mail________________________
Child’s School:________________________ Teacher___________________________
Please check the areas in which you can help:
_____Field Trips _____ Work with a small group _____ Tutor one-to-one
_____Library Aid _____ Kids on the Block Puppets _____ Xeroxing
_____ Heads Up _____ Child Outreach Screening _____ Other_______________
Days and times you are available:____________________________________________
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