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Dependent FormGinger Hall2025-09-16T13:57:06-04:00

Dependent Form

Dependent Name #1(Required)
This dependent is a:(Required)
Is your son or daughter still in school?
Do you have a 2nd Dependent to add:
Dependent Name #2
This dependent is a:
Is your son or daughter still in school?
Do you have a 3rd Dependent to add:
Dependent Name #3
This dependent is a:
Is your son or daughter still in school?
Do you have a 4th Dependent to add:
Dependent Name #4
This dependent is a:
Is your son or daughter still in school?
Do you have a 5th Dependent to add:
Dependent Name #5
This dependent is a:
Is your son or daughter still in school?
Do you have a 6th Dependent to add:
Dependent Name #6
This dependent is a:
Is your son or daughter still in school?
Consent to Electronic Signature
By selecting the "I Agree to the Consent to Electronic Signature" button or by electronically signing this document, I acknowledge and agree that:

-I am providing my electronic signature, which I intend to have the same legal effect as a handwritten signature.
-I consent to the use of electronic signatures and electronic records in connection with this agreement, transaction, or communication.
-I understand that my electronic signature is legally binding and equivalent to a manual signature under applicable laws, including but not limited to the U.S. Electronic Signatures in Global and National Commerce Act (E-SIGN) and the Uniform Electronic Transactions Act (UETA).
-I have the option to receive a paper copy of this agreement or to sign a paper version if I choose, and I may request this by contacting [insert contact information].
-I confirm that I have the necessary hardware and software to access, view, and retain electronic records and that I can access the electronic documents associated with this agreement.
-I agree that my electronic signature may be used for any documents or communications related to this transaction or agreement, as permitted by law.

-If I wish to withdraw my consent to electronic signatures or records, I understand that I may do so by contacting Ginger Nicholson, gdh@hlma.net, in writing, though this may affect my ability to participate in certain transactions or agreements.
-By providing my electronic signature, I affirm that I have read, understood, and agree to be bound by the terms of this consent and any associated agreements.

About HLMA

HLM Associates is a veteran-owned security consulting firm that provides professional security services and staff augmentation for the Department of Defense, Intelligence Community, Civilian agencies, and Private Sector Industrial Base.

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3226 Harmony Hollow Rd
Front Royal, VA 22630

contact@hlma.net
(413) 489-4562

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