STEP 1 of 3: STUDENT INFORMATION

Welcome to registration for Teen Health Camp - Oahu, November 19, 2016 at the John A. Burns School of Medicine. Please complete information below (STEP 1) AND the survey (STEP 2). You will also need to have your parents or legal guardian complete and submit "Parent Information and Consent" in STEP 3. Thanks for signing up!

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* 1. Last Name

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* 2. First Name

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* 3. Middle Name

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* 4. Preferred Name

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* 5. Contact Information

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* 6. Primary Social Network

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* 7. Date of Birth

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* 8. Gender

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* 9. Legal Residency

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* 10. School Currently Attending

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* 11. Grade

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* 12. What is your ethnicity? (Please select all that apply.)

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 33% of survey complete.

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