Register for HLC Hangouts: Ages 10-12

Participant Information

Have you attended Camp HLC or other HLC programs before?

Parent/Guardian Information

Relationship to Participant

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.

ALS Information

Who has ALS in your family & what is their relationship to the participant?
Is this person currently battling ALS?
Has your child exhibited any of the following? Please check all that apply.
Does your child utilize any coping skills? Please check all that apply.

Participant Questionnaire

If you are completing this registration on behalf of your children, please help your children fill out these questions and thank you so much.

If no, would you like to meet/connect with another child, teenager, or young adult who has or has had a loved one living with ALS?
Are there any areas of support currently available to you? Please check all that apply.


What technologies do you have at home? Please check all that apply.
Parents and Guardians: what social media platforms do you use? Please check all that apply.
Children: what social media platforms do you use? Please check all that apply.

Hope Loves Company

How did you hear about Hope Loves Company?

Waiver and Release

Waiver and Release Agreement

I (the "PrimaryContact/Releasor") plan to participate in virtual programs, events, and/or activities ("Activities") hosted by Hope Loves Company, Inc. (the "Host").

In consideration of being allowed to participate in these Activities, I do hereby represent that I am physically able and mentally prepared to participate in the Activities which I opt to attend.

I release, waive, discharge, hold harmless and indemnify the Host, their directors, officers, employees, and volunteers (collectively "Releases") from any and all known or unknown, foreseen or unforeseen, consequences including expenses, costs, and attorney's fees, arising out of or in any way associated with my participation in the given Activities, to the fullest extent permitted by law.

Meeting Decorum

I agree to maintain proper decorum throughout the Activities, which includes making sure that I will be properly dressed, am in a proper location and there are no inappropriate images, art, or photos that can be seen in the broadcast with me; and there will be no inappropriate noises in the background, such as TV, music, or conversations that could be broadcast over the video record.

Cyberbullying and Harassment Agreement

Threatening, intimidating, harassing, bullying, coercing and/or engaging in other conduct which is threatening or endangering to the health, safety, or wellness of any person is prohibited.

Bullying is a repeated pattern of willful, conscious behavior intended to hurt, threaten or embarrass an individual or group.

Some examples of bullying include:

  • Using offensive names, teasing or spreading rumors about others or their families
  • Putting down or belittling others' abilities and achievements
  • Making degrading comments about another's culture, religious or social background
  • Hurtfully excluding others from a group
  • Ridiculing others' appearance
  • Tormenting, threatening, harassing, humiliating, embarrassing or otherwise targeting another person, HLC staff member, facilitator, or volunteer through the use of the internet, email, interactive or digital technologies or through the use of a mobile phone

Sexual abuse includes any sexual activity with a child where consent is not or cannot be given.

Hope Loves Company, Inc does not tolerate bullying or any form of harassment, whether it be physical, verbal, or cyberbullying. All HLC Staff and volunteers are committed to ensuring a safe and caring environment which promotes emotional support and education for children, young adults, their families and caregivers.

Misuse of Technology

Abuse of the Hosts technology is prohibited. Violations consist of theft and/or other abuse of computer time, including but not limited to:

  • Unauthorized entry into a file to use, read, or change the contents, or for any other purpose
  • Unauthorized transfer of a file
  • Unauthorized use of another individual's identification and/or password
  • Use of computing facilities to interfere with the work of another HLC Staff member, facilitator, or volunteer
  • Use of computing facilities to send obscene, abusive, or threatening messages
  • Use of computing facilities to interfere with normal operation of the Host's computing system

Recording and Property Ownership

The Host is committed to providing confidential services to its users. No information given to the organization will be shared with any other organization or individual without the user's expressed permission.

The Host holds personal data about its staff, users, members, etc. which will only be used for the purpose for which it was gathered and will not be disclosed to anyone outside of the organization without their prior permission.

All personal data will be dealt with sensitively and in the strictest confidence internally and externally.

Taking unauthorized pictures or video of the Host's property is prohibited. Use of a recording device, including but not limited to audio, video, or digital, for the purpose of recording any staff member, volunteer or user while participating will not be tolerated.

Confidentiality Policy

Respecting the privacy of our clients, former clients, staff, donors, members, and volunteers is a basic value of the Host. Personal and financial information is confidential and should not be disclosed or discussed with anyone without permission or authorization from The Host, 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, volunteers, and clients of The Host may be exposed to information which is confidential and/or privileged and proprietary in nature. It is the policy of The Host 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 The Host is confidential. "Confidential" means that you are free to talk about The Host 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 The Host, staff and our clients rely on paid and volunteer staff to conform to this rule of confidentiality.

Photo & Video Release

I hereby irrevocably grant to the Host, 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 the Host, its contractors, its employees and any third parties involved in the creation of The Host'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 the Host 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 The Host'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 The Host from all claims of every kind on account of such use.

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