Club Heal the Bay Registration Form
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.

We offer a benefits program for all registered clubs- help raise environmental awareness and protect what you love, all while collecting service hours and "Club Drops" fir 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 Jenn Swart at jswart@healthebay.org

Your Club's Name
Your answer
# of Club Members to-date
Example: 2, 50, etc.
Your answer
Your School's Name
Your answer
Your Club Leader's Name
First, Last
Your answer
Club Leader's Grade Level
Club Leader's Email
What is the best email to reach you with? One that you check frequently.
Your answer
Club Leader's Phone Number (1)
What is the best source to reach you on?
Club Leader's Phone Number (2)
Please enter the number for the phone you selected above (xxx-xxx-xxxx).
Your answer
Club Leader's Home Address
Used to send you Heal the Bay materials. Example: 123 Easy Street #4, Los Angeles, CA 98765
Your answer
Club Co-Leader's Name (optional)
First, Last
Your answer
Club Co-Leader's Email
What is the best email to reach you with? One that you check frequently.
Your answer
Club Co-Leader's Grade Level
Your Club Adviser's Name
Is there a teacher or adult who helps you with your club? If you don't have one mark "n/a"
Your answer
Your Club Adviser's Email
Your answer
How did you hear about Heal the Bay?
Please choose the most relevant.
Required
Type of work your club is interested in.
Please choose all that apply.
Required
Why would you like to partner with Heal the Bay?
What do you hope to achieve with your club?
Your answer
What is your club Mission Statement?
How does the club plan on achieving its goal(s)? What steps will the club take to get closer to its goal(s)?
Your answer
Is your club interested in helping members get volunteer or service hours?
If so, how many hours do you need to fulfill?
Your answer
Emergency Contact Name
First, Last
Your answer
Emergency Contact Phone Number
Example: (xxx-xxx-xxxx)
Your answer
Emergency Contact Relationship
Example: Father, mother, sibling, etc.
Your answer
Volunteer Commitment Agreement
Please check to agree.
As a club partner, 1 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 leader, I will ensure that my club members will remain professional and considerate while representing Heal the Bay.
As a club partner, our club will participate in a minimum of 3 Heal the Bay volunteer opportunities for each school year.
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