Wall of Fame Request Form
Thank you for sharing your precious child with us!

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/

To add your child to the Wall of Fame, please provide the information below.

Thank you!
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Email *
After you complete this form, please email the Hunter's Hope Family Programs, fp@huntershope.org, with a high resolution head shot photo of your child. Please use your child's first and last name for the file name of the photo and make sure the photo is jpg or png format.  Also, please put "Wall of Fame" in the Subject Line of the email. Thank you!
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? *
Don't forget to email fp@huntershope.org a photo of your child as described above.
A copy of your responses will be emailed to the address you provided.
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