Membership Onboarding – Autism Home Base

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Membership
Information

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Getting To
Know You

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Registration &
Payment

We do not share information with any external parties. Feel free to check out our Privacy Policy. If you have any questions, please contact us.

We want to get to know you better! Please take the time to fill out the personal profile form below so that we can connect you with people and programs that will interest you.

If you are a parent/caregiver, please fill out this form on behalf the autistic adult you care for.

I'm here because ...

What Is Important To Me

What I Like To Do

What You Should Know About Me

How To Support Me

Social Cues?

Schedules?

Preferred Contact Method?

Friends/Family?

You’re almost there! To complete your membership registration, please click the button below to create your Members Area account. You will need your Members Area account to view and pay invoices, update membership information, see latest updates, view our programs list, sign up for events, and submit support requests.

After creating your account, log into the Members Area to view and pay your membership invoice.

Please do not leave this page until you have clicked the button below – you will not be able to create your Members Area account without it!

Main Participant

First Name

Last Name

Phone number

Email Address

Date of Birth (MM-DD)

account administrator for billing

First Name

Last Name

Phone Number (Cell)

Street Address

City

Province

Postal Code

Date of Birth

How did You Hear About Us?

Membership Terms

Memberships are not refundable or transferable. Autism Home Base (AHB) reserves the right to suspend, refuse or revoke a membership without reimbursement if terms of agreement are broken. The following consent by Account Administrator includes all participants under this paid membership:

Annual Fee: Members pay a $100 annual fee per family ($150 for the first year) due January 1st each calendar year. Fee can be paid by cash or cheque payable to "Autism Home Base Durham" or by etransfer to accounting@autismhomebase.com

Annual Give Back: Members agree to contribute a minimum of 10 volunteer hours per calendar year. This can include holding or supporting fundraising events, advocacy, outreach and mentorship, or by supporting program delivery. Members are encouraged to share your special interests and skills by offering program suggestions. All members ensure facilities and equipment are left in a clean and orderly condition after use.

Code of Conduct: Each member, volunteer, staff and instructor contributes to our safe, welcoming space and should promote acceptance and inclusion. All members shall abide by AHB's commitment to choice, respect, dignity, integration and equality.
Notwithstanding individual rights to freedom of expression, discussions and actions that could be offensive or triggering to others such as conversations about acts of violence or sexual objectification, must be avoided. Attire displaying profanities or disrespectful content is not permitted.

We have a zero tolerance for comments designated under the national Hate Crime Act including prejudice based on race, gender or gender identity, religion, disability, sexual orientation, or ethnicity.

Bullying or harassment of members, volunteers, staff or community partners is not tolerated.

Families are first and foremost responsible for monitoring and managing conduct and should provide communication and behavioural supports. Staff, instructors, and other members may also provide reminders, if necessary. Repeated occurrences may result in temporary participation restrictions or permanent membership suspension.

I accept

At the Hub: Members are invited to help themselves to games, equipment and use of the self-serve kitchen. Members should bring their own refreshments. Snacks and beverages are available by donation.

Caregivers: Members who require support must be accompanied by a family caregiver/guardian who is 18 years of age or older and who will participate in the activity. In the event that a family caregiver is unavailable, paid caregivers may attend as support no more than 10% of sessions. Our family caregivers appreciate opportunities to network and connect with their peers. Paid caregivers are the responsibility of the family and as such will be should be fully briefed about the group and expectations for participation in advance.

I accept

Acknowledgement of risks: I understand and agree that there are risks, both foreseeable and unpredictable, associated with the activities we undertake through AHB. I assume the risk and responsibility for any injury, death or property damage resulting from our participation in activities organized through AHB.

Release and Indemnity: I release, indemnify and hold harmless AHB and it’s servants and agents, from and against all and any actions or claims which may be made by me or on my behalf or by other parties for or in respect or, or arising out of, any injury, loss, damage or death caused to me or my property whether by negligence, break of contract or in anyway whatsoever.

I accept

Media Consent: I give permission to AHB to take photos and videos during planned activities of which I may appear in. These photos and videos may be used for promotional use on print and online in public platforms. This includes the website, social media sites such as Facebook and Twitter, and any marketing material to be produced in the future. It is my responsibility to let photographers know I don't want to be included in group photos and to avoid being photographed if I opt out of Media Consent.

I accept (you can opt out in your member profile)

Voting: Each paid account shall name a membership administrator who will be entitled to receive notice of Members' Meetings and is invited to attend, speak and vote at Member Meetings.

I accept

Digital Signature

I have read, understand, and accept the above terms as outlined.