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
Please select...
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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
Please select...
Male
Female
Prefer not to answer
Race/Ethnicity
American Indian/Alaska Native
Asian
Black/African American
Hispanic/Latino
Native Hawaiian/Pacific Islander
White
Mark all Races that apply to you.
Who do you live with most of the time?
Mom
Dad
Step Mom
Step Dad
Mom's Boyfriend/Partner
Dad's Girlfriend/Partner
Brother(s)
Sister(s)
Other Relatives
Foster Parent(s)
Group Home
Where do you live MOST of the time? Mark all Living Demographics that apply to you.
What grade are you in?
Please select...
6
7
8
9
10
11
12
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
Please select...
Yes
No
How did you hear about H20?
Please select...
H20 Staff
Therapist/Social Worker
Teacher/School Counselor/School Staff
Probation Officer
Pastor/Minister/Church Staff
Parent/Other Family Member
Other Teen/Friend
School Event
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
Please select...
Mom
Dad
Step-Mom
Step-Dad
Guardian
Foster Parent