Life Skills Class, Summer 2019

Holiday Baking and Gift Giving Life Skills Class

November 2020
November-December 2020 SESSION

When: Monday, November 16th - December 14th (5 weeks)

1 1/2 hrs.

Cost: $125

Location: ASRC 4476 S. Dort Hwy, Burton, MI 48529 (Life Skills classes are held in Garrett's Place, the back building on our property)
To register, you must have approval and class placement from Amy Morris, Director of Family & Community Education, and the following must be submitted:

1. This completed online Registration Form and Signed Waiver

2. The ASRC Needs Assessment (You may have already completed this if your child has participated in a previous class/POWER Athletics or Camp/or with your Membership Application. See Amy Morris to confirm).

3. Payment In Full

Payment can be made using a credit card via the link to online payment at the end of this form on the "Thank you" page.** Cash or check (made payable to ASRC) can be deposited in the secure drop box affixed to the front building or mailed. We are located at 4476 S. Dort Hwy, Burton, 48529

**Small credit card fee applies to online credit card payments

Parent Information
Parent/Guardian Name *

First Name Last Name
E-mail *
Home Number *

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Given the pandemic, we will have certain guidelines which will require your compliance. They are as follows and are subject to change:
- Masks are required
- Online Health Screening is required prior to attending each week.
- Classes are drop off. Parents are not permitted to enter the building to keep the number of people at a minimum.
- Temperatures of all attendees will be checked on site prior to being admitted to the building
I agree to comply with COVID 19 guidelines

Participant Information
Participant Name *

First Name Last Name
Email *
example@example.com
Cell Phone *

Area Code Phone Number
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Other Medical Conditions/Diagnoses. *
Any allergies to foods? *
Favorite Food *
Do you have experience using a stove? *
Does you have experience using sharp knives? *

Autism Support & Resource Center (ASRC)

WAIVER, RELEASE OF LIABILITY, ACKNOWLEDGEMENT OF RISK AND

INDEMNITY AGREEMENT

In consideration of being permitted to participate in Autism Support & Resource Center (ASRC) activities in any capacity, I, for myself and for my heirs, next of kin, assigns and personal representatives:
1. Understand that my execution of this Waiver is a prerequisite for my participation and/or the participation of my child(ren) or ward of whom I am the parent or guardian (“my child”), in the Event.
2. Understand that I am solely responsible for the health and safety of myself and/or my child, and represent that I and/or my child is in good health and physically capable of participating in this Event. If at any time during my and/or my child’s participation in the Event I feel like my and/or my child’s physical condition no longer allows me and/or my child to participate or I believe the Event becomes unsafe, I will immediately stop my and/or my child’s participation. I will abide by all Event rules and will be responsible for ensuring that my child will do so.
3. Acknowledge and understand fully that there are risks and dangers of serious bodily injury and death that could result from my and/or my child’s participation in the Event. I understand that in order to be allowed to participate in the Event, I agree to fully accept and assume all risks and all responsibility for any injury, losses and damages to person or property that I and/or my child may incur as a result of my and/or my child’s participation in the Event.
4. Hereby agree to release and hold harmless the ASRC, the owner or possesor of the venue, and their past and present affiliates, assigns, successors in interest, agents, servants, employees, volunteers, participants, officers, directors and sponsors, and all government and public entities including, but not limited to, the State, County and local municipalities where the Event takes place (collectively the “Released Parties”).
5. Understand and agree that this release will have the effect of releasing, discharging, waiving, and forever relinquishing any and all actions or causes of action that I and/or my child may have, whether past, present or future, whether known or unknown, arising from, resulting from, or in connection to the Event. This release constitutes a complete release, discharge and waiver of any and all actions or causes of action that I and/or my child may have against the Released Parties, including but not limited to any claims for personal injury, property damage, or wrongful death and including but not limited to any injuries resulting from negligent actions or omissions.
6. Irrevocably authorize the ASRC to use my and/or my child’s recorded voice, image and likeness in any medium including, without limitation, video, photograph, film, tape, and digital medium, for any lawful purpose. I understand that neither I nor my child will receive any compensation for the use of my and/or my child’s recorded voice, image and likeness in promotional materials and waive rights to any compensation now or in the future.
7. Have carefully read this Waiver and fully understand its contents. I am aware that this is a release of liability and I sign of my own free will. I intend this to be a complete and unconditional release of all liability to the greatest extent allowed by the law, even though that liability may arise from the negligence or carelessness of the Released Parties listed above, and I agree that if any portion of this agreement is held to be invalid, the remaining portion of the agreement shall continue to be in full force and effect.
Initial to agree with terms of waiver
Should be Empty:

Holiday Baking and Gift Giving Life Skills Class