Wall of Fame Request Form
Please provide us with the information to add your child to our Wall of Fame.
Please allow 5 business days for your information to be updated on the Wall of Fame web page. If you do not see your child within 5 business days of submitting your information, please contact us at
If your child is affected by a Leukodystrophy, please make sure that you have registered as an affected Leukodystrophy family with Hunter's Hope. If you have not yet registered, please do so here:
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Affected Child's First Name
Affected Child's Last Name
Affected Child's Birthdate
Affected Child's Heaven Date (if applicable)
Affected Child's City
Affected Child's State
Leukodystrophy or other Sickness of your Affected Child, that you would like shown on the Wall of Fame for your child.
Name of person filling out form
Relationship to Child (Please know that you must have legal permission to share child's information with us to be used on the Wall of Fame.)
If you answered "Other" to the question above, please describe.
Do you give permission to Hunter's Hope to use your child's photo and the information provided on this form?
Please email a close-up picture of your child's face to firstname.lastname@example.org. Please include your child's first and last name with the photo with the subject line "Wall of Fame".
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Hunter's Hope Foundation.