Wufoo

  • Select the Summer 2017 class or classes for which you would like to register. *
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  • Will the participant be attending with a PCA? *
  • Participant has attended another AuSM Social Skills class in 2017. *
  • I am joining AuSM today. *
  • Joining AuSM Today - Which category best describes you? *
  • Membership Category *
  • Emergency Contact and Medical Information

  • Photo/Video Release and Information Sharing

  • I give the Autism Society of Minnesota (AuSM) permission to publish photographs or video of the AuSM Social Skills class participant in any promotional material without incurring any liability to AuSM or any photographer/videographer hired on behalf of AuSM. Names will NOT be used with the photographs. The materials may include, but are not limited to, newsletters, annual reports, brochures, advertisements, websites, social media sites, training materials, and/or posters.
  • I give the Autism Society of Minnesota (AuSM) permission to share my contact information with other participants in this AuSM Social Skills class. This allows students to keep in touch with each other if they desire to do so during and after the class.
  • My AuSM Profile

    Please complete information about the class participant.
  • Please select two social skills you would like AuSM instructors to focus on during this class. *
  • Release of Liability

  • I hereby agree/grant permission for the participant to take part in all AuSM Social Skills activities.

    I am/the participant is participating in AuSM Social Skills upon the express agreement and understanding that I hereby waive and release the Autism Society of Minnesota and each of its Social Skills locations and each entity's staff, directors, affiliates, partners, officers, agents, contractors, employees, and each entity's affiliates from any and all claims, costs, liabilities, expenses, or judgements.

    This includes attorney fees and court costs (heron collectively "Claims") arising from my participating in/the participant participating in AuSM Social Skills or any illness or injury resulting from, and hereby agree to indemnify and hold harmless: the Autism Society of Minnesota and each of its Social Skills locations and each entity's direct and indirect parents and subsidiaries, any of their affiliated entities, successors, and current or future director, officer, employee, partner, member, or agent of any of them from and against any and all such Claims. *
  • Demographic Information

  • Please specify participant's ethnicity. *
  • Please select participant's gender. *
  • Select your household annual income. *