H3- Happy, Healing and Healthy Participant Registration

Welcome to your journey toward health and well-being! This form registers you into H3, and because the program is funded by the San Francisco Sugary Drinks Distributor Tax, we need to collect some demographic questions and water/sugary drinks intake info. Thank you for taking the time to complete this registration survey. You only need to fill this out once.

First Name

Last Name

Phone

Mailing Street

Mailing City

Mailing State

Mailing Zip

Age

What was your total household income before taxes during the past 12 months?

Gender

Please Specify

Ethnicity

Please Specify

Would you like to select a second ethnicity?

YesNo

Ethnicity

Please Specify

How many ounces of sugary drinks do you have per day?
(Sugary drinks include soda and other carbonated soft drinks, sports drinks, energy drinks, fruit-flavored or powdered drinks, vitamin-enhanced drinks, and sweetened tea and coffee drinks)

How many 8 oz glasses of water do you drink per day?

How many hours a week of physical activity do you get per week on average?

How did you hear about the H3 Program?

Who referred you?

Once you submit this form, you will then see links to our different classes. Click the link for which class you'd like to attend first, and then you'll pick a date and fill in your details. Thank you! We look forward to being part of your journey in health.

Contact Information