extrinsic.

[  ] smoked [ x ] consumed alcohol [ x ] slept in the same bed with someone of the opposite sex [ x ] slept in the same bed with someone of the same sex [ x ] kissed someone of the same sex   [ x ] had sex [ x ] had someone in your room other than family [ x ] watched porn [  ] bought porn [  ] tried drugs

TOTAL: 7

[ x ] taken painkillers [   ] taken someone else’s prescription medicine [ x ] lied to your parents [ x ] lied to a friend [ x ] snuck out of the house [ x ] done something illegal [ x ] felt hurt [ x ] hurt someone [  ] wished someone to die [ x ] seen someone die

TOTAL: 8

[  ] missed curfew [ x ] stayed out all night [ x ] eaten a carton of ice cream by yourself [ x ] been to a therapist [  ] received a ticket [   ] been to rehab [ x ] dyed your hair [   ] been in an accident [ x ] been to a club [ x ] been to a bar

TOTAL: 6

[ x ] been to a wild party [  ] been to a Mardi Gras parade [ x ] drank more than three alcoholic beverages in a night [  ] had a spring break in Florida [  ] sniffed anything [ x ] wore black nail polish [  ] wore arm bands [ x ] wore t-shirts with band names [ x ] listened to rap

TOTAL: 5

[  ] dressed gothic [ x ] dressed girly [ x ] dressed punk [ x ] dressed grunge [  ] stole something [ x ] been too drunk to remember anything [ x ] blacked out [  ] fainted [  ] had a crush on a neighbour

TOTAL: 5

[ x ] had a crush on a friend [ x ] been to a concert [   ] dry-humped someone; been dry humped [  ] been called a slut [  ] called someone a slut. [   ] installed speakers in a car [ x ] broken a mirror [ x ] showered at someone of the opposites sex’s house [ x ] brushed your teeth with someone else’s toothbrush

TOTAL: 5

[   ] considered Ludacris your favorite rapper? [ x ] seen an R-rated movie [ x ] cruised the mall [ x ] skipped school [ x  ] had surgery [  ] had an injury [ x  ] gone to court [  ] walked out of a restaurant without paying/tipping [ x ] caught something on fire. [  ] lied about your age

TOTAL: 6

[ x ] owned/rented an apartment/house [  ] broke the law in the police’s presence [  ] made out with someone who had a GF/BF [ x ] got in trouble with the police [ x ] talked to a stranger [ x ] hugged a stranger [  ] kissed a stranger [  ] rode in the car with a stranger [ x ] been harassed [ x ] been verbally harassed

TOTAL: 6

[ x ] met face-to-face with someone you met online [ x ] stayed online for 5+ hours straight [ x ] talked on the phone for more than 4 hours straight [ x ] watched TV for 5 hours straight [ x ] been to a fair [  ] been called a bad influence [  ] drank and drove [ x  ] prank-called someone [ x ] laid on a couch with someone of the opposite sex [  ] cheated on a test

TOTAL: 7

GRAND TOTAL: 55