General information
Parent's or legal guardian's information
Last Name *
Your answer
First Name *
Your answer
Relationship *
Cell phone number #1 *
Your answer
Cell phone number #2
Your answer
E-mail address *
Your answer
Address *
Your answer
Emergency contact
Your answer
Student's information
Last Name *
Your answer
First Name *
Your answer
Cell phone number (only used during the week of the Teen Summit) *
Your answer
Student's e-mail address *
Your answer
Birth date *
MM
/
DD
/
YYYY
School grade for the year 2018/2019 *
Gender *
Native language
Your answer
Ethnicity *
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