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* 1. YOUR NAME OR CHILD'S NAME:

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* 2. Would you use or benefit from Grange Moor Primary School running a breakfast club each weekday?

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* 3. If you answered yes, how many days would you use it each week?

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* 4. If you wouldn't use it regularly, would you consider using it occasionally if you needed to or do you have other arrangements in place?

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* 5. If you would use it regularly or occasionally, what time would you like it to start?

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* 6. Any further comments?

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