Triangle D&A University Winter 2026 Class Registration

Triangle D&A University Winter 2026 Class Registration

Class descriptions can be found at https://triangledisability.org/services-programs/classes
Participant Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth*

MonthDayYear
Date
FemaleMaleNon-BinaryOtherChoose not to answer
Asian/Pacific IslanderBlackLatinXNative/Alaskan Native AmericanWhiteOtherChoose not to answer
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CareGiver/Parent/Guardian Information
Name (if applicable)

First NameLast Name
Email (if different from participant)
example@example.com
Phone Number (if different from participant)
Please enter a valid phone number.Format: (000) 000-0000.
Address (if different from participant)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cooking & Nutritition Class Registrants Only

List any Food AllergiesList any Dietary Restrictions
My Classes
Media Consent I hereby authorize Triangle Disability & Autism Services, Inc. to photograph/video the Participant. The photographs/videos may be used for the following purposes (please check all that apply):

Publicity for Triangle Disability & Autism Services (ex. Training, news articles, press releases, Newsletter/E-Newsletter)

Internet: Triangle Disability & Autism Services Website or Social Media (Names will NOT be used on social media or our website)
Media Consent for Publicity for Triangle Disability & Autism ServicesMedia Consent for Internet- TDAS Website or Social MediaI do not give consent
Informed Consent and Acknowledgement I agree to participate in the community programs of Triangle Disability & Autism Services, Inc. I understand that taking part in this event is completely my choice. I understand that there is no anticipated risk or discomfort from participation in the program. I also understand that I may decline/refuse to participate in any part of the program and may withdraw my consent to participation at any time. I understand the venues where these events may be held cannot be held liable for any accident/emergency occurring during a Triangle Disability & Autism Services community program. I understand Triangle Disability & Autism Services community programs do not provide one-on-one supports/supervision.

Medical Release and Authorization In the event of a medical emergency involving the Participant, I give my permission to Triangle Disability & Autism Services, Inc. to attempt to reach the emergency contact(s). If the situation necessitates, the staff members have my permission to provide first aid/CPR and/or seek emergency medical treatment for the Participant. I further agree to be responsible to all costs attached to this treatment. I release Triangle Disability & Autism Services and its staff members from any further liability.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

My Products

Cooking & Nutrition

Durham- Tuesdays, 2:30pm, beg 1/6/26 (8 weeks)

$105.00 Quantity

Gentle Yoga

ONLINE- Thursdays, 6:00pm, beg 1/8/26 (8 weeks)

$25.00 Quantity

Total

$0.00

Credit Card

Should be Empty:

Triangle D&A University Winter 2026 Class Registration

Participant Information

CareGiver/Parent/Guardian Information

My Classes

Credit Card