Family Hui Registration Form
You are invited!  

Here are some of the benefits you can expect for you, your children and your family from Family Hui’s parenting program:

*Peer support from other parents as you experience the joys and challenges of raising your children
*Up to date information about child development and resilience, and how to use the information effectively
*Knowledge about local resources available to you and how to access them
*Formation of lifelong friendships with other members of your hui – an ongoing community of support

What is a hui? It is simply a small group, 7 – 10 families, with common goals and interests – learning from and supporting each other on the journey we call parenting.
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Email *
Participant Information
First and Last Name *
Address: House Number and Street *
City *
Zip Code *
Phone Number *
Date of Birth *
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What language(s) are spoken at home? *
Required
Do you have Medical Insurance? *
If YES, please indicate what type of insurance. *
Is this your first Family Hui? *
If no, where and when did you participate?
How did you hear about Family Hui? *
Consent Agreement *
Required
Pre-Survey
I feel connected with other families. *
I am confident as a parent. *
I can manage the stresses of raising a child. *
I feel that I am a strong advocate for my child(ren). *
Child(ren) Ages 0-5
Child #1: First and Last Name
Child #1: Age
Child #1: Date of Birth
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DD
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Child #1 -- Does your child have any special needs or dietary restrictions?
Clear selection
Child #1 -- If YES, please specify.
Child #2: First and Last Name
Child #2: Age
Child #2: Date of Birth
MM
/
DD
/
YYYY
Child #2 -- Does your child have any special needs or dietary restrictions?
Clear selection
Child #2 -- If YES, please specify.
Child #3: First and Last Name
Child #3: Age
Child #3: Date of Birth
MM
/
DD
/
YYYY
Child #3 -- Does your child have any special needs or dietary restrictions?
Clear selection
Child #3 -- If YES, please specify.
Child(ren) Ages 6+
Tell us how many child(ren) you have that are 6 years old and older.
Clear selection
Family Hui Agreements
Family Hui Expectations *
Photo/Video/Audio Consent
I hereby grant permission to Lead4Tomorrow/Family Hui the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied,
exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my
likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the
use of my image or recording. I also understand that this material may be used in diverse educational
settings within an unrestricted geographic area.

Photographic, audio or video recordings may be used for the following purposes:
• conference presentations
• educational presentations or courses
• informational presentations
• on-line educational courses
• educational videos


I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting.
By checking below, I understand this permission signifies that photographic/video recordings of me may be used. *
Acknowledgement
By typing my name below, I have completed this form to the best of my knowledge and agree to all the terms and conditions of my participation. *
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