TreeHouse Student Enrollment

Enroll Below

First Name *

Middle Name

Last Name *

Email Address *

Your Cell Phone *

Home Phone *

Date of Birth *

Age *

Gender: *

Grade *

Name of Your School *0 / 5

TreeHouse Location *Select which TH location you attend

Parent/Guardian’s Email *

Parent/Guardian’s First Name *

Parent/Guardian’s Last Name *

Parent/Guardian’s Cell Phone *

Street Address *Enter the address of where you live MOST of the time

City *

State/Province *

ZIP / Postal Code *

Who do you live with most of the time? *One ParentBoth ParentsFoster/Group HomeOther

Do you receive free or reduced lunch at school? *YesNo

What is your race/ethnicity? (Check all that apply) *American Indian/Alaska NativeBlack/African AmericanNative Hawaiian/Pacific IslanderAsianHispanicWhiteOther

How did you find out about TreeHouse? (Check all that apply) *Other teen/friendTeacher/School Counselor/School StaffProbation OfficerPastor/Minister/Church StaffParent/Other Family MemberTherapist/Social WorkerTreeHouse StaffOther / PATH PROGRAM

Please do not fill in this field.