Register – HangOutHive

First Name*

Last Name*

E-mail Address*

Cell Phone Number*

Address*

Password*

Confirm Password*

List your primary registered disability*

Did anyone assist you with this registration. If so, who

Challenges*

If utilizing a support individual, please define what types of support you receive in managing any challenges (therapy, other groups, Support staff)

Do you know any existing member? If so, who?

How did you hear about the HangOut Hive?

How will you contribute to the group?*

What expectations do you have by registering?*

Birth Date (must be 21+)*

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I agree to the following membership requirements:*

- Birth age of 21 or greater- Be identified with a disability

- Able to handle and engage in electronic communications- Able to get self to and from events

- Able to understand and pay personal costs at events- Able to comprehend verbal communication

- Able to act appropriately towards other members- Agree to abide by the HOH rules

- Pay $25 Annual Dues within 2 weeks of registration acceptance notification

By submitting this membership application I agree to be bound by each of the following Conduct Rules*

- All information within the HangOut Hive meeting is considered Confidential- There will be no drugs or alcoholic beverages consumed at HangOut Hive Events

- No vaping or smoking is allowed with the proximity of a HOH meeting or event.- All members will treat other members with respect and kindness: No harassment, threats of violence, no retaliation nor discrimination will be tolerated.

- Any action or communication showing disrespect and causing fear and/or humiliation will result in that member being removed from the group

Emergency Contact Name*

Emergency Contact Phone*

Emergency Contact email*

Support Staff Name

Support's Phone Number

Support's Email Addesss

Is there anything else you would like to share?

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Sun	Mon	Tue	Wed	Thu	Fri	Sat
27	28	29	30	1	2	3
4	5	6	7	8	9	10
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Sun	Mon	Tue	Wed	Thu	Fri	Sat
27	28	29	30	1	2	3
4	5	6	7	8	9	10
11	12	13	14	15	16	17
18	19	20	21	22	23	24
25	26	27	28	29	30	31
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