Background: Little is known regarding youth perceptions of tap water and school water fountains and how these relate to water and sugar-sweetened beverage (SSB) intake. Methods: We used national 2010 YouthStyles data to assess perceptions of tap water and school water fountains and associations with water and SSB intake. Results: Nearly 1 in 5 participants disagreed their tap water was safe and nearly 2 in 5 disagreed school water fountains were clean and safe. Perceived tap water risk was more prevalent among non-Hispanic (NH) Blacks (26.4%) and Hispanics (28.3%) compared with NH Whites (14.7%, p?<0.001) and more prevalent among lower-income youth. Negative water fountain perceptions were more common among high school-aged youth. Perceived tap water risk was not associated with SSB intake (odds ratio [OR]?=?1.0, 95% confidence interval [CI]: 0.6, 1.5) or water intake (OR?=?1.4, 95% CI: 0.9, 2.1). Negative water fountain perceptions were associated with SSB intake only among Hispanics (race/ethnicity interaction p?<?0.001; OR?=?2.9, 95% CI: 1.3, 6.6) but were not associated with water intake. Conclusion: Negative perceptions of tap water and water fountains among youth are common and should be considered in efforts to provide water in schools.