Exit this survey Alternative Teen Break 2016 Question Title * 1. Please fill out the information below. First Name: Last Name: Address: City: State: Zip: Home Phone: Cell Phone: Email: Question Title * 2. Please fill out the demographic information below. Gender: Date of Birth: Age: Grade: Graduation Year: School District: School Name: Question Title * 3. Do you currently attend a Title I school and/or receive a free or reduced lunch? Yes No Question Title * 4. How did you find out about Alternative Teen Break (ATB)? Teacher Friend/Family Member Houston Zoo Facebook Houston Zoo Website Houston Zoo Email Next