Helping Hands Foundation, Inc.

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Name and Address

First Name *

Last Name *

Street Address (Home)

City (Home)

Postal Code (Home)

Country (Home)

State (Home)

Member Profile

Member Type *

Profession

First Name of HHF Child/Member (Parent of HHF child must complete)

Last Name of HHF Child/Member (Parent of HHF child must complete)

Child Date of Birth

Relationship to HHF Child/Member

(i.e., parent, aunt, grandmother, friend, doctor)

Brief description of upper limb difference

If possible, please include prosthetic use, surgeries/procedures performed, etc.

Other Parent/Guardian First Name

Other Parent/Guardian Last Name

How did you hear about us? *

Reason for Interest in HHF *

Comments/Questions

i.e., HHF child's sibling names and year of birth, concerns, ideas for our website, etc.

E-mail address *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password

Confirm password

Provide a password for the new account in both fields. If left blank, a password will be generated for you.

Locale settings

Time zone

Select the desired local time and time zone. Dates and times throughout this site will be displayed using this time zone.

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