Hang Tough Hero Family Sign Up
Do you have a Hang Tough Hero?  Do you want to be included on all the fun and exciting family events and programs that Hang Tough offers?   The form is quick and easy--and then you are in!  

We serve any children aged 0-21 that have been diagnosed with a chronic or life-altering illness as well as a special need.  Geographically, we serve families in Leon, Gadsden, Jefferson, and Wakulla counties.  
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Email *
Parent/ Guardian First Name *
Disclosure:  Hang Tough Foundation (HTF) does abide by HIPAA policies and only necessary personnel has access to the information on this form and they been HIPAA certified and trained.  I understand that HTF will keep my child's diagnosis on file and HTF has a dedication to protect and secure our personal health information.
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Parent/ Guardian Last Name *
Relationship to Child
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Second Parent/ Caregiver First Name
Second Parent/Caregiver Last Name
Relationship to Child
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Street (Mailing Address) *
City (Mailing Address) *
State *
Zip *
County *
Phone number *
How did you hear about Hang Tough?
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Hang Tough Hero Information
We call the families we serve our Hang Tough Hero Families and your child(ren) with the diagnosis, our Heroes.
Hero's First and Last Name *
Preferred Pronouns
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Gender *
Birthdate *
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Diagnosis
Hero T-shirt Size *
Required
If you have an additional hero in your household, please list the same information here.  (Name, Date of Birth, Preferred Pronouns, Gender, T-Shirt Size and Diagnosis.)
Hang Tough Sidekick Information
We call the siblings of Hang Tough Heroes "Sidekicks".  Every Hero needs a Sidekick and we want to get to know your Heroes Sidekick(s).
Sidekick first name
Sidekick last name
Sidekick birthday
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YYYY
Preferred Pronouns
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Additional Sidekick first name
Additional Sidekick last name
Sidekick birthday
MM
/
DD
/
YYYY
Preferred Pronouns
Clear selection
Additional Sidekick  first name
Additional Sidekick last name
Preferred Pronouns
Clear selection
Sidekick birthday
MM
/
DD
/
YYYY
For any additional Sidekicks please enter their name, birthday, and preferred pronouns below:
All Sidekicks T-shirt  Size (If you need multiple shirts in one size, please notate this in "other")
Demographic Information
The information collected below will be used for the purpose of grant applications and reporting the demographics of families served.  Completing this information will help Hang Tough grow and continue to provide services to the community.  
Household Income
Race/Ethnicity of a child, please choose all that apply
If Bi-racial was marked above, please specify here
Please list all schools your children currently attend:
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