Teen and Adult Registration for "BE SAFE" Movie Screenings
This is the registration form for "BE SAFE Interactive Movie Screenings." Sessions are from 6:00 pm to 8:30 pm for the interactive sessions for teens and adults with an autism spectrum disorder or an intellectual or developmental disability.
Training is provided by the ARC of Southern Maryland. All training is free and all materials are provided.

This Google Form may be used by teens and adults directly, or by the parent or caregiver of any teen or adult with ASD, ID or DD interested in attending "BE SAFE." Registrants must be at least 13 years of age and must be able to attend to instruction for up to 30 minutes at a time. Short breaks will be provided.

This form is NOT intended to be used by law enforcement or first responders, or disability service providers, special educators, disability support advocates, or any professionals working in these fields. You may register for "Understanding Autism" and/or "BE SAFE" at the "LEO/FIRST RESPONDER TRAINING" webpage on our ASSG website instead if you wish to volunteer or observe. For further details please go to http://autismsupport-somd.org/

Please indicate the date and location you wish to register for, and the individual who will be attending on that date. If you have more individuals who you are registering, or if you wish to register individuals for additional dates, simply submit a new form. You may also request a spreadsheet for data entry for multiple attendees from, or email the information to, June at jnicholas@autismsupport-somd.org. If you have any questions, please call ASSG at (240) 561-8860 or contact us by email. Seating is limited.

Email address *
I would like to attend "BE SAFE" as teen or adult with a disability on the date indicated: *
First Name of Registrant: *
Your answer
Last Name and Suffix (Jr, III, etc.) *
Your answer
My age is (indicate years only): *
Your answer
My parent or caregiver's name is:
Your answer
Phone Number and Extension: *
Your answer
County You Live In: *
Comments, Questions, or Accommodations Desired:
Your answer
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Autism Spectrum Support Group of Southern Maryland.