Screen Reader Mode Icon

Question Title

* 1. Please type your first and last name. (either parent or student/young adult filling this out)

Question Title

* 2. If you're the parent and filling this out for your student/young adult, please type their first name (18 & under). First and last name for (18 & up). Otherwise, skip.

Question Title

* 3. Please provide your home address if you would also like to receive Songs for Sound mailings, udpates and newsletters.

Question Title

* 4. What day of the week is best for you and your child to attend a Hope Young People Gatherings?

Question Title

* 5. Please provide more grade/age information.

Question Title

* 6. What types of activities would your child like to do? (Rank most preferred to least preferred).

Question Title

* 7. Each Hope Gathering will have an educational presentation prior to the social outing. (Rank most preferred to least preferred).

Question Title

* 8. What type of device/company you have? (ex: cochlear implant/company name or hearing aid/company name)

Question Title

* 9. How would you like to receive additional information about the event?

Question Title

* 10. If you will not be attending please explain why.

Question Title

* 11. We are working with hearing companies to provide additional benefits to our Hope Families including discounts and more educational materials. 91% of our families want to receive this information. Please advise if you would like to be included on these announcements.

( Privacy & Cookie Notice
0 of 11 answered
 

T