Kea'au High School 2018 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
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