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 fp@huntershope.org.

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: https://www.huntershope.org/family-care/hope-for-families/get-support/

Thank you!
Email address *
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.
Email address *
Phone number *
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 fp@huntershope.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.
Never submit passwords through Google Forms.
This form was created inside of Hunter's Hope Foundation. Report Abuse