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

Club Name *
Your answer
School Name *
Your answer
Number of Club Members *
Your answer
Club Leader Name *
First and Last
Your answer
Club Leader Email *
Please include an email you check frequently!
Your answer
Club Leader Grade Level *
Club Leader Home Address *
We use this to send Heal the Bay materials (Ex: beach cleanup supplies)
Your answer
Club Co-Leader Name (optional)
First and Last
Your answer
Club Co-Leader email (optional)
Your answer
Club Co-Leader Grade Level (optional)
Club Adviser Name *
Is there a teacher or parent who helps you with your club? If not, please put "N/A"
Your answer
Club Adviser Email *
If not applicable, please put "N/A"
Your answer
Club Email
If your club has an official club email in addition to your club leader's we can use this as another way to get in touch with the club to coordinate events/meetings.
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Use format: xxx-xxx-xxxx
Your answer
Emergency Contact Relationship *
Mother, father, sibling, etc.
Your answer
Club Instagram
So we can connect with you from our Club Heal the Bay instagram account! We also use this information to tag your club in photos we post on the ClubHtB Instagram page. Check it out @clubhealthebay
Your answer
Why would you like to partner with Heal the Bay? *
What do you hope to achieve with your club? 1-3 sentences
Your answer
Skills your club may have: *
Choose all that apply
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
Is your club interested in helping members get volunteer hours or service hours? *
If yes, how many hours do you need to fulfill?
Your answer
Volunteer Commitment Agreement *
Please check to agree
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.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms