Program Registration

Annual Teen & Young Adult Prom - June 2024
06/21/2024 05:45 PM - 07:45 PM ET

Admission

  • $15.00

Location

Prism Academy
166 Lincoln St
Berlin, CT 06037
Room Number: Gymnasium

Summary

Annual prom for our teen and young adult participants to dress up, dance, and socialize with peers!

Registrant Contact Information

Are you registering yourself or someone else? 

"Registrant" information below is for the person filling out this form (that's you!).

"Attendee" information is for the person being signed up for the program (on the next page).

If you are registering someone else, uncheck the box  that says "Include myself as attendee."

If you are a teen or young adult signing yourself up for a program, leave the box that says "Include myself as attendee" checked.

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Waiver Statement:

Liability Waiver

I realize that, as with any physical activity, there is a possible risk of accidental injury to me/my child while participating in this Autism Families CONNECTicut program. I agree to assume the risk of any injury which I/my child might suffer while involved in the Autism Families CONNECTicut program and will not hold Prism Academy (the landlord), the town of Berlin, Autism Families CONNECTicut, or the board, staff, instructors, and volunteers liable for any injuries which I/my child might suffer while participating in this Autism Families CONNECTicut program.

Photo/Video Release

Autism Families CONNECTicut has an OPEN PICTURES POLICY. Individuals attending programs may have their photos and/or videos taken. Photos and/or videos may be used for program development, education and training, marketing materials - including but not limited to newspaper articles, television promotions, brochures, social media (Facebook, YouTube, Instagram, website, etc.), and funding materials - such as annual reports, board meeting materials, sponsorship documents, etc. Photos and/or videos may be used by Autism Families CONNECTicut’s funders in any of their promotional or marketing materials. I may opt out of this policy if I do not wish for my child to have their picture taken.

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