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 or would like to learn more about the Camp HLC experience, please contact Shannan Sullivan, Executive Director, at shannon.sullivan@hopelovescompany.org or Cara Haggerty, Program Director, at cara.haggerty@hopelovescompany.org or call 609-730-1144.

Camp HLC Registration

Camper Information

Age at Camp
Race (check all that apply)
Are you a returing 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

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

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