Dance Registration Form : Autism Resource Center : What We Do : The Arc of the South Shore

The Autism Resource Center offers community dances at The First Parish of Norwell. Dances are for individuals over the age of 18 and celebrate various holidays and times of the year.

Dances provide social and recreational opportunities in a safe and supported environment. They are a great opportunity for self-expression, meeting new people, and building relationships. Individuals of all abilities are welcome at these events. If the attendee needs additional support in a large group setting, they are welcome to bring a support staff at no cost. Tickets for attendees are $25.

All attendees are required to have a signed registration form on file prior to the dance in order to attend. Please fill about the form below; forms will not be accepted at the door.

For questions or more information, please email Diane Wilcox.

Dance Registration Form

Participant Name

First Name *

Last Name *

Parent/Guardian Name

First Name *

Last Name *

Participant's Address

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

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Phone

Emergency Contact Name

First Name *

Last Name *

Emergency Contact Phone

Please list any known allergies and/or medications.

Please list any special needs, behavioral concerns, and/or any other information that may be helpful.

Please note, light food is served, and we cannot be responsible for individuals with food allergies.

I agree
I do not agree

I agree to assume all responsibility for all risk, damage, or injury that may occur to me as a participant in this activity/event. In consideration for being accepted as a participant, I hereby for myself, my heirs, executors and administrators, release and discharge The Arc of the South Shore, the staff, and volunteers from all claims, damages, rights of action, present and future, whether the same be known, anticipated or unanticipated, resulting from or arising out of, or in incident to, my participation in this activity/event. I grant permission to be medically treated and/or receive medical emergency services at a local hospital. I also grant permission for the use of my name, picture, and or videotape in any broadcast, photograph, or other account of this event.