ACEing Autism Registration Form

Age should be 5 or greater as of February 17th, 2020

Detailed Information

Communication Questions

Please describe your child's expressive language skills:

Please describe your child's receptive language skills:

Recreational Activities

Has your child participated in any of the following organized programs?

Background / Education Questions

Family Demographics

ACEing Autism Policies and Procedures

Liability Waiver Form for ACEing Autism, Inc.

To the best of my knowledge, I am in good physical condition and fully able to participate in the ACEing Autism, Inc. Tennis Program. I am fully aware of the risks and hazards connected with the participation in this event, including physical injury or even death, and hereby elect to voluntarily participate in said event, knowing that the associated physical activity may be hazardous to me and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in this program.

I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, ACEing Autism, Inc., their volunteers, officers, servants, agents, and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in physical activity, or while on or upon the premises where the program is being conducted.

It is my expressed intent that this release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVE, DISCHARGE, and CONVENTION TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of the state where my ACEin Autism program takes place.

In signing this release, I acknowledge and represent that I HAVE READ THE FORGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.

Photography, Film, or Vocal Recording Release

ACEing Autism, Inc. may take many pictures/video of the children throughout the year.

Note: I authorize this release based on the following conditions.

These records become the property of ACEing Autism or its representatives. 

This release is given without promise of compensation. 

This release is effective until terminated by a retraction in writing from the person granting this authorization. 

The parent/legal guardian and the participant do release to ACEing Autism any right, title and/or interest of any kind they may have in the records produced. 

I hereby grant to ACEing Autism, Inc. the right and authority to photograph, film and/ or record vocally.

These records may be used for promotional, publicity or teaching purposes and may be published in mass media publications, on the intranet or Internet sites, or shown on television or movie presentations. The participant’s and family’s name may be used. This release is effective until revoked in writing by the undersigned. Such revocation shall only be effective to prevent any expanded future use of the records.

Program Policies

Inclement Weather Policy

If a class must be cancelled due to inclement weather, we will notify you at least 1 hour prior to the start of the clinic.

Refund Policy If ACEing Autism must cancel a clinic due to inclement weather we will provide you with a credit for the next session or a reimbursement for the canceled clinic.

Refunds will not be issued for participant cancellations.

Safety Policy At any time a child's participation in ACEing Autism can be terminated if there is a safety concern that is not able to be fully addressed to maintain the safety of all children in the program.

ACEing Autism aspires to serve as many individuals with autism as possible. Your donation will help us to defray the cost and/or provide scholarships for those in need.  Thank you for your kind consideration!

Suggested Amounts

This page is secured with 256 bit encryption

Reg Fox by Webconnex
Secure Online Registration Powered by RegFox