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" 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 Halina Do-Linh (Clubs Coordinator) at hdolinh@healthebay.org

Your Club's Name *
Your answer
Your School's Name *
Your answer
Number of Club Members *
Your answer
Your Club Leader's Name *
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 number 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
Your answer
Club Co-Leader's Name (optional)
First, Last
Your answer
Club Co-Leader's Grade Level
Club Co-Leader's Email
What is the best email to reach you with?
Your answer
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
Emergency Contact Name *
First, Last
Your answer
Emergency Contact Phone Number *
ex: xxx-xxx-xxxx
Your answer
Emergency Contact Relationship *
Mother, father, sibling etc
Your answer
Club Instagram Handle
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.
Your answer
Club Email
If your club has an email in addition to that of the leader, we can use this as another way to get in touch with the club so we can coordinate events/meetings.
Your answer
Why would you like to partner with Heal the Bay? *
What do you hope to achieve with your club?
Your answer
Skills your club may have: *
Please choose all that apply.
Required
Type of work your club is interested in: *
Please choose all that apply.
Required
Interests your club may have: *
Please choose all that apply.
Required
How did you hear about Heal the Bay *
Please choose the most relevant.
Is your club interested in helping members get volunteer hours or service hours? *
If so, how many hours do you need to fulfill?
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.
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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