Camp HLC Registration

Thank you for your interest in attending Camp HLC! Camp HLC is a free weekend retreat for children, teens, young adults, and families affected by ALS or Lou Gehrig's disease. Please know that the entire family is invited to camp and that people living with ALS can also join us. If you are living with ALS and intend to join us, please contact us so that we can best meet your needs.

Camp HLC is a wonderful opportunity for families affected by ALS to come together to connect with peers who share in their experiences, enjoy recreational activities such as swimming, hiking, archery, and more, and create long-lasting memories and connections.

We can't wait to see you all in-person and online!

If you have any questions between now and then, please feel free to contact our Program Manager, Linda Sermons at linda.sermons@hopelovescompany.org or 640-203-0154. You can also contact our Executive Director, Shannon Sullivan at shannon.sullivan@hopelovescompany.org or 640-203-0345.

Camp HLC Registration

Camper Information

Age at Camp
Race (check all that apply)
Are you a returning camper? (Have you attended Camp HLC before?)

Hope Loves Company

How did you hear about Hope Loves Company?

Parent/Guardian Information

Parents and guardians are invited to attend Camp HLC, too!

Typically, we recommend that children under the age of 12 come to camp with an adult family member or adult chaperone. If a child under the age of 12 attends without a chaperone, they will be assigned a 1:1 volunteer chaperone called a "Big Buddy," - big buddies are in the same cabin/group with their little buddy and will attend activities and meals together. If you have any questions, please call us to discuss at (609) 730-1144.


Will Parent/Guardian be attending Camp?

If Parent/Guardian will be attending camp, please complete the following:

Add Parent 2

Financial Information

Your household income section is optional. However, It will help us with grant information to help more kids and families affected by ALS.

Emergency Contact Info

Preferred Emergency Contact 1 (if not parent/guardian 1 attending Camp HLC)

Preferred Emergency Contact 2 (if not parent/guardian 2 attending Camp HLC)

Health Insurance Company

Camper Health Information

Food Allergies or Dietary Restrictions (Check all that apply.)

ALS

Who has ALS in your family & what is their relationship to the camper?
Is this person currently battling ALS?
Has your child exhibited any of the following? (Check all that apply.)

Camp Transportation

Child Drop-Off and Pick-Up Authorization

Person other than parent/guardian authorized to drop off and/or pick up child. No one will be permitted to pick up your child if their name is not listed above. All persons must have and show their picture ID. This requirement is necessary to account for all campers and to keep them safe.

Photo & Video Release

I hereby irrevocably grant to Hope Loves Company®, Inc., its subsidiaries, affiliates, licensees, successors and assigns the perpetual, worldwide right to use, publish, and reproduce, for all purposes my name, image, likeness, voice, and/or quotations in any and all media, languages, formats and markets now known or hereafter devised.

I hereby release Hope Loves Company, Inc., its contractors, its employees and any third parties involved in the creation of Hope Loves Company, Inc.’s publications, from liability for any claims by me or any third party in connection with my participation or the participation of the minor child listed below. Further, I attest that I am the parent or legal guardian of the child listed above and that I have full authority to consent and authorize to execute this Release.

I further grant Hope Loves Company, Inc. all right, title, and interest that I may have in all finished pictures, negatives, reproductions, and copies of the original works, and further grant the right to give, sell, transfer, and exhibit the works in copies or facsimiles thereof, for promotional, commercial or other purposes, as it relates to the mission of Hope Loves Company.

I hereby waive the right to receive any payment for signing this release and waive the right to receive payment for Hope Loves Company, Inc.’s use of any of the material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, audio, video, multimedia, or advertising recordings and copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied. Further, I hereby release Hope Loves Company, Inc. from all claims of every kind on account of such use.

Certification

Confidentiality Policy - for families

Respecting the privacy of our clients, former clients, staff, donors, members, and volunteers of Hope Loves Company, Inc. itself is a basic value of Hope Loves Company, Inc. Personal and financial information is confidential and should not be disclosed or discussed with anyone without permission or authorization from Hope Loves Company, Inc. Care shall also be taken to ensure that unauthorized individuals do not overhear any discussion of confidential information and that documents containing confidential information are not left in the open or inadvertently shared.

Employees and volunteers of Hope Loves Company, Inc. may be exposed to information which is confidential and/or privileged and proprietary in nature. It is the policy of Hope Loves Company, Inc. that such information must be kept confidential both during and after employment or volunteer service. Staff and volunteers are expected to return materials containing privileged or confidential information at the time of separation from employment or expiration of service.

All information concerning our clients, former clients, staff, donors, members, volunteers, financial data, and business records of Hope Loves Company, Inc. is confidential. “Confidential” means that clients, former clients, staff, donors, members, and volunteers are free to talk about Hope Loves Company, Inc. and about the programs, but are not permitted to disclose client names or talk about them in ways that will make their identity known. No information may be released without appropriate authorization. This is a basic component of client care and business ethics. The Board of Directors of Hope Loves Company, Inc., staff and our clients rely on paid and volunteer staff to conform to this rule of confidentiality.

Certification

Confidentiality Policy - for volunteers

Respecting the privacy of our clients, former clients, staff, donors, members, volunteers and of Hope Loves Company, Inc. itself is a basic value of Hope Loves Company, Inc. Personal and financial information is confidential and should not be disclosed or discussed with anyone without permission or authorization from Hope Loves Company, Inc. Care shall also be taken to ensure that unauthorized individuals do not overhear any discussion of confidential information and that documents containing confidential information are not left in the open or inadvertently shared.

Employees and volunteers of Hope Loves Company, Inc. may be exposed to information which is confidential and/or privileged and proprietary in nature. It is the policy of Hope Loves Company, Inc. that such information must be kept confidential both during and after employment or volunteer service. Staff and volunteers are expected to return materials containing privileged or confidential information at the time of separation from employment or expiration of service.

All information concerning our clients, former clients, staff, donors, members, volunteers, financial data, and business records of Hope Loves Company, Inc. is confidential. “Confidential” means that you are free to talk about Hope Loves Company, Inc. and about the programs and your position, but you are not permitted to disclose client names or talk about them in ways that will make their identity known. No information may be released without appropriate authorization. This is a basic component of client care and business ethics. The Board of Directors of Hope Loves Company, Inc., staff and our clients rely on paid and volunteer staff to conform to this rule of confidentiality.

Certification

Sexual Abuse Policy and Procedure Agreement

Hope Loves Company, Inc. has zero tolerance for sexual abuse at the Hope Loves Company, Inc. workplace, at Camp HLC, or at any Hope Loves Company, Inc. event. Hope Loves Company, Inc. has procedures for staff, volunteers, family members, victims of sexual abuse, and others to report sexual abuse. Sexual abuse includes any sexual activity with a child where consent is not or cannot be given.

Some, but not all of the physical and behavioral evidence or signs that someone is being sexually abused include:

  • Difficulty in walking
  • Torn, stained or bloody clothing
  • Pain
  • Bruises or bleeding in the genitalia
  • Reluctance to be left alone with a particular person
  • Wearing lots of clothing
  • Fear of touch

Some, but not all examples of unacceptable behaviors (i.e. high-risk behaviors) include:

  • Unwarranted, unwanted and/or inappropriate touching of a child
  • Bullying or harassment of a child
  • Inappropriate contact or relationships between employees/volunteers and children within the organization

Responding appropriately to Child Abuse:

  • Stay calm so as not to scare the child.
  • Comment on and ask non-leading questions about suspicious injuries.
  • Let the child know they did the right thing by telling and that they are not to blame.
  • Avoid making promises you can’t keep such as you’ll never have to speak about it again.
  • Report suspected child abuse immediately using procedures provided.

Designated Person:

  • Every person is responsible for ensuring the safety of the children but the executive director (or their designee) is specifically responsibility for implementing this policy and serving as the contact person.
  • Everyone at Hope Loves Company Inc. needs to know who the designated contact person is and how to reach them.

Reporting Procedures:

  • Volunteers/staff are required to report suspected child abuse to the executive director (or their designee) immediately, understanding that retaliation is prohibited against the person who makes the good faith report of sexual abuse.
  • The Executive Director (or designee) will immediately report suspected child abuse to the State reporting agency/Police and have all information from the child’s application form available, as needed.
  • If possible, the Executive Director (or designee) as well as the volunteer/staff reporting the abuse will file a report together.
  • The volunteer’s reporting obligation is not fulfilled until they confirm that a report is made.
  • It is important that the report be made as early as possible.

At Camp HLC, the designated Contact Person is the Executive Director of Hope Loves Company, Shannon Sullivan. Shannon’s cell phone number is (640) 203-0345.

Certification

Waiver & Release Agreement

I [Name of Participant] plan to participate in any programs, events, and/or camp activities (“Activities”) at CAMP HLC (the “Host”) by Hope Loves Company, Inc. In consideration of being allowed to use the facilities and participate in any of the Activities, I, the Participant, do hereby:

  1. Represent I am physically able and mentally prepared to participate in all Activities.
  2. Release waive, discharge, hold harmless and indemnify Hope Loves Company, Inc., their directors, officers, employees, and volunteers (collectively “Releases”) from any and all known or unknown, foreseen or unforeseen, bodily or personal injuries, death and permanent injury, illnesses, damage to property, or other losses, and any consequences thereof, including expenses, costs, and attorney's fees, arising out of or in any way associated with my participation in the given Activities, or travel incidents, to the fullest extent permitted by law.
  3. Assume full responsibility for, and risk of, bodily injury, death or property damage due to the negligence of Releasees or otherwise.
  4. Authorize Hope Loves Company, Inc. staff, representatives, contractors, or other medical personnel to obtain or provide medical care for me or my child, to transport me or my child to a medical facility and to provide treatment (including hospitalization, medications, anesthesia, surgery) they consider necessary for my or my child’s health. I agree to release (to or by the Host) of any records necessary for treatment, referral, billing or insurance purposes. I agree to pay all costs associated with any medical care and/or transportation, including medical and/or airlift evacuation and related expenses.
  5. Understand that I am solely responsible for my transportation to and from CAMP HLC.
  6. Understand that I am not to leave the campgrounds for any reason and if I do, will not be permitted to return to our program.
  7. Understand that I will need to sign our Sexual Abuse and Confidentiality policy once at camp.
  8. Understand that I will follow the camp rules for the health and welfare of all campers.

The Undersigned has read and voluntarily signs this form, and further agrees that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.

Certification

Close Icon
Thank you We appreciate you contacting us! We try to respond as soon as possible, so we will be in touch shortly!
Click to close this window.
Hope Loves Company Login
Show Password
DirectLync loading
Username and Password combination is incorrect.