1. Kids Juice Intake and Carotenoid Effect

Please complete the following information for one child. If you have multiple children who are interested in participating, complete additional surveys.

* 1. Is your child age 5-17?

* 2. Please list your child's birthdate (mm/dd/yyyy)

* 3. What is your child's gender?

* 4. What is your child's race or ethnicity?

* 5. Is your child willing to drink a juice supplement twice a day for eight weeks?

* 6. Are you and your child able to attend clinic appointments weekdays between 7:00-9:00 am or after school once a week for eight weeks?

* 7. Does your child have diabetes, asthma, or rheumatoid arthritis?

* 8. Does your child have a chronic disease or condition?

* 9. If yes, please list.

* 10. Please enter the child's name.

* 11. Please enter a parent/guardian's name and address.

* 12. Best daytime contact number for parent/guardian xxx-xxx-xxxx:

* 13. How did you learn about this study?

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