Listen to Me! Hawaii 2025 - Reunion Family Application

We are thrilled to host our third LTM Hawaii Reunion event for all previous attending Listen to Me! Hawaii families. Although it includes time to reconnect with old friends, the reunion is packed with educational presentations, parent training rotations, discussion groups, and a family support group.

This year we are offering 2 onsite locations:

Lehua Elementary School, Pearl City, Oahu
Imua Family Services, Kahului, Maui

Costs will range from $25--$100 per family, depending on household income.

The LTM Reunion is designed to continue educating and supporting parents as they continue on their journey of having a child with hearing loss, acknowledging that families have different needs than they did when attending the initial Listen to Me! week.

Conference date is: October 11, 2025

Deadline to submit: September 12th, 2025

After you submit this registration, Danielle Bourque will follow up with you directly regarding a registration fee for your family. (Based on household income level).

Parent / Guardian

Name of Parent/Caregiver completing this form

Please provide the names of all parents/caregivers who will attend the LTM Reunion

Name of Parent/Caregiver 1 attending the LTM Reunion

Name of Parent/Caregiver 2 attending the LTM Reunion

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Child

Name of your Child with Hearing Loss

Date of Birth

mm/dd/yyyy

Child's Current Age

How many other siblings will participate?

Primary language spoken by your family

The cost for attending Listen to Me is based on a sliding fee scale

If your family is chosen to attend Listen To Me, we will notify you of the financial cost for your family according to the sliding fee scale

Annual Household Income

# of People in Household

Location

Which location will you attend?

Personal Appearance Release

PERSONAL APPEARANCE RELEASE

I authorize Producer to record and edit into the Program and related materials my name, likeness, image, voice, interview (the “Recordings”). Producer may use and authorize others to use all or parts of the Recordings. Producer, its successors and assigns shall own all right, title and interest, including copyright, in and to the Program, including the Recordings, to be used and disposed of without limitation as Producer shall in its sole discretion determine.

PERSONAL APPEARANCE RELEASE

Persons Appearing (List all family members participating):

Allergy Information:

Name of person(s) in family with allergies we should be aware of:

Allergic to:

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Listen To Me! Hawaii 2025 Reunion - Parent Authorization

Signature Authorization - Parent / Guardian

After you submit this registration, Danielle Bourque will follow up with you directly regarding a registration fee for your family. (Based on household income level).

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