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Maltby Center’s Video Vault Registration Form

Maltby Video Vault
Parent/Guardian name
Parent/Guardian name
First
Last
Child’s name
Child's name
First
Last
Address
Address
City
State/Province
Zip/Postal
Does your child have an Autism Spectrum Disorder diagnosis?
How did you hear about our workshops?
Which workshop videos are you interested in? (check 2)

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