Weber-Morgan Health Department

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Class & Date (View Descriptions /Info):
Youth Tobacco Awareness (Youth Tobacco Awareness Classes are FREE for first offenders.) Youth Tobacco Cessation (Youth Tobacco Cessation (END) is for second offenders. A $25, non-refundable cash fee must be paid before class begins. Payment must be submitted in person at Weber-Morgan Health Department, 477 23rd Street, 3rd floor Health Promotions Office.)
Student Information:
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Date of Birth: (mm/dd/yy)
Check One:	Male Female
Parent / Guardian Information:
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Referral Source:
Juvenile Court Municipal Court (Judge Name: ) Local Police School Other: