Kea'au High School 2017 Summer Bridge Program Application & Consent Form
Please fill out and answer all questions in their entirety. Mahalo!

This organization does not tolerate any form of discrimination, harassment, or bullying because of a student's race, color, national origin, disability, sex, age, gender identity and expression, socio-economic status, physical appearance, sexual orientation, and/or religion.

Last Name
Your answer
First Name
Your answer
Gender
Birth Date
MM
/
DD
/
YYYY
Previous School
Your answer
Home Address
Your answer
City
Your answer
Zip Code
Your answer
Home Phone Number
Your answer
Unlisted?
Mailing Address (if different from home address)
Your answer
City
Your answer
Zip Code
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Keaau Secondary Schools. Report Abuse - Terms of Service - Additional Terms