Central East – Lindsay – Tech Lab

Registration Profile

First Name *

Middle Name

Last Name *

Email *

Phone *

Address *

Address 2

City *

Country *

Province *

Postal Code *

Languages spoken at home *

Registration Fee(s)

Family Ticket. Limit 1 max. *

Autistic person *

# of Sibling/friends

# of Parent/Caregiver

Total

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Phone *

Child 1 with ASD

First Name

Last Name

Birth Date

Identifies As

Child 2 with ASD

First Name

Last Name

Birth Date

Identifies As

Child 3 with ASD

First Name

Last Name

Birth Date

Identifies As

Child 4 with ASD

First Name

Last Name

Birth Date

Identifies As

Waivers

It is recommended that participants consult their physician prior to the start of any physical activity. By registering for or participating in an Autism Ontario program or event, participants agree that they are and will be voluntarily participating in these activities and assume all risks of injury or death, which might result from these activities.

Waiver #1 - Consult Physician

I agree

I acknowledge and understand that supervision of children/youth is the sole responsibility of parents/guardians and caregivers and release Autism Ontario, its employees, officers, director and agents from all claims arising from any accident, death or injury which is caused by or arises from participation in any Autism Ontario event. This includes in-person and on-line events. Parents/caregivers must remain present.

Waiver #2 - Adult Supervision

I agree

I understand that tickets are non-transferable and non-refundable unless otherwise posted.

Waiver #3 - Tickets are Non-Transferable

I agree

I understand that this event is only for people with an ASD diagnosis and their immediate family members.

Waiver #5 - Open to Families of Children w ASD

I agree

I understand photography may be taken at this event and understand these photos may be used for printed or online material. I hereby waive any claim against Autism Ontario and staff, for any personal or emotional distress that may arise in connection with the use of the material(s). I understand that there will be no compensation to me for the use of the material(s).

Waiver #6 - Photography

Yes

Due to allergies and sensitivities, please refrain from wearing perfume, cologne, aftershave, or scented products such as hairspray or lotion.

Waiver #7 - Allergies

I agree

This is not my primary address

Child Details

Child 1

Child First Name

Child Last Name

Child Birth Date

Child Gender

English
French
Arabic-Arabe
Bengali-Bengali
Cantonese-Cantonais
Cree-Cri
German-Allemand
Hindi-Hindi
Inuktitut-Inuktitut
Italian-Italien
Mandarin-Mandarin
Ojibway-Ojibway
Persian (Farsi)-Persan (farsi)
Polish-Polonais
Portuguese-Portugais
Punjabi-Pendjabi
Russian-Russe
Spanish-Espagnol
Tagalog-Tagalog
Tamil-Tamil
Urdu-Ourdou
Vietnamese-Vietnamien
Other Indigenous Language-Autre langue autochtone
Other Language-Autre langue
Bilingual