Club Heal the Bay Registration
Interested in partnering your middle or high school club to Heal the Bay's mission, campaigns, and events? Please have your club leader register your club with us using the following form.

Help raise environmental awareness and protect what you love, all while collecting service hours and "Club Drops" for every project you complete. Three drops in the year gets you and your club an invite to our beachy celebration at the end of the school year. Hope to see you there!

For more information visit www.clubhealthebay.org or email Danielle Furuichi (Programs Coordinator) at dfuruichi@healthebay.org
Email address *
Club Name : *
School Name: *
Number of Club Members: *
Club Leader Name: *
Date of Birth (mm/dd/yyyy) *
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Club Leader Email: *
Please include an email you check frequently!
Club Leader Grade Level: *
Club Leader Home Address: *
Club Co-Leader Name (optional)
First and Last
Date of Birth (mm/dd/yyyy)
MM
/
DD
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YYYY
Club Co-Leader email (optional)
Club Co-Leader Grade Level (optional)
Club Adviser Name: *
Club Adviser Email *
Club Email:
Emergency Contact Name: *
Emergency Contact Number: *
Use format: xxx-xxx-xxxx
Emergency Contact Relationship: *
Club Instagram:
Why would you like to partner with Heal the Bay? *
Skills your club may have: *
Required
Type of work your club is interested in: *
Choose all that apply
Required
How did you hear about Heal the Bay? *
Choose the most relevant one for you
Required
Is your club interested in helping members get volunteer hours or service hours? *
Volunteer Commitment Agreement *
yes
Column 3
Agree
agree
Column 5
As a club partner, ONE or more of our club members will attend a volunteer orientation.
As a club partner, our club will be dependable, reliable and on time while representing Heal the Bay.
As a club partner, our club will participate in a minimum of THREE Heal the Bay volunteer opportunities for each school year.
As a club leader, I will ensure that my club members will remain professional and considerate while representing Heal the Bay.
Heal the Bay will not tolerate physical, verbal or visual conduct that creates a hostile work environment. Behavior that is offensive, intimidating or abusive in nature, especially behavior that relates to such things as an individual’s race, color, sex, religion or national origin, are prohibited. These prohibited acts include, but are not limited to, racially or ethnically degrading statements, sexual advances and proposals. Violations of this policy will lead to discipline up to and including termination. If you are not clear about Heal the Bay’s Harassment/Sexual Harassment policy, please contact the Volunteer Manager for further clarification. I agree to Heal the Bay’s Harassment/Sexual Harassment policy.
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