New Student Registration

Site ID

Site Owner

Site Email

Contact Information

First Name

Middle Initial

Last Name

Preferred Name

Street Address

Apt Number

City

State

Zip Code

Email Address

School ID

Phone Information

Home Phone Number

Cell Phone Number

Do you want to receive texts from H20?

Would you like to opt-in to receiving text messages from H20? You can expect to receive messages a few times a week about fun events or calendar reminders. Standard messaging and data rates will apply. You can opt-out any time.

Youth Information

Date of Birth (MM/DD/YYYY Format)

Sex

Race/Ethnicity

American Indian/Alaska NativeAsianBlack/African AmericanHispanic/LatinoNative Hawaiian/Pacific IslanderWhiteMark all Races that apply to you.

Who do you live with most of the time?

MomDadStep MomStep DadMom's Boyfriend/PartnerDad's Girlfriend/PartnerBrother(s)Sister(s)Other RelativesFoster Parent(s)Group HomeWhere do you live MOST of the time? Mark all Living Demographics that apply to you.

What grade are you in?

Which school are you currently attending?

School Salesforce ID

I could not find my school on that list.

What's your school name?

Reduced/Free School Lunch

How did you hear about H20?

Who told you about H20?

Start typing your friend's name and then select their name from the list.

Referral ID

TreeHouse Site

Parent Information

Guardian First Name

Guardian Last Name

Guardian Cell Phone

Guardian Work Phone

Guardian Email Address

Relationship to youth