Student Name and Last Name (You only need to enter one student name and ID number per household)
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Student ID Number
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School
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Ethnicity Disclaimer: Ethnicity information will be collected by the Department of Public Health (DPH) This enables them to obtain funding that supports meetings such as this) *
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Parent/Guardian First Name *
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Parent/Guardian Last Name *
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Contact Number (optional)
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In which language do you want to hear the presentation?
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A copy of your responses will be emailed to the address you provided.