Registration
PLEASE NOTE: This registration includes BOTH Family Information and Student Information. We recognize that some questions may feel repetitive, and we appreciate your patience. Our system also supports youth program enrollment at The Center, which is why these sections appear in this format. When "Adding New Student", simply enter the information for yourself as you will be receiving access to the classes and resources. Ages 18 and above
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info (Not Contact #1 or #2)*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
How did you hear about The Hive? *
What brings you to The Hive at this time in your journey?*
What type of cancer are you navigating, and where are you in your treatment or recovery process?*
What are the biggest challenges you’re facing?*
What does support look like for you in this season?*
What are you hoping to gain from being part of The Hive community?*
 
Additional Information:
 
General Liability Waiver & Release of Claims
  (Show-Hide Details)
I've read the above and agree.
 
Medical & Wellness Services Consent
  (Show-Hide Details)
I've read the above and agree.
 
Mental Health Services Disclosure & Scope of Practice
  (Show-Hide Details)
I've read the above and agree.
 
Independent Contractor Acknowledgment
  (Show-Hide Details)
I've read the above and agree.
 
Media & Photography Release
  (Show-Hide Details)
I've read the above and agree.
 
Childcare Waiver & Emergency Consent
  (Show-Hide Details)
I've read the above and agree.
 
Confidentiality & Community Conduct Agreement
  (Show-Hide Details)
I've read the above and agree.
 
Informed Consent for Participation in Group Activities
  (Show-Hide Details)
I've read the above and agree.
 
Data Use & Privacy Agreement
  (Show-Hide Details)
I've read the above and agree.
 
HIPAA Acknowledgment of Understanding
  (Show-Hide Details)
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments: