ASL Class Registration Form
Registrant Information
We are so pleased you're interested in registering for an American Sign Language class at Deaf Action Center! Please complete this form to register. You will receive a confirmation email with your registration details. Thank you!
Contact Details
First Name
Last Name
Phone
How did you hear about us?
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Television Segment/News
Web Search (Google, Yahoo, etc)
DAC Website
Friend or Family Member
Radio Ad
Other
Email
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Street Address
City
State
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AL
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CA
CO
CT
DE
DC
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HI
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LA
ME
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MA
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PA
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VA
WA
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Zip/Postal Code
I am
Deaf
Hearing
Hard of Hearing
Class Selection
All classes take place from 6:30-8pm Central, unless otherwise noted.
What Level of ASL Class are you interested in?
ASL 101
ASL 102 (Pre-Requisite: ASL 101)
ASL 103 (Pre-Requisite: ASL 101, 102)
ASL 104 (Pre-Requisite: ASL 101, 102, 103)
ASL 101-104 (See All Adult Classes)
Please Select the
ASL 101 Class
You Would Like to Enroll In
ASL 101 - Virtual Lunch (Nov 14 to Dec 13, 2023 12 - 1 pm Central)
Please Select the
ASL 102 Class
You Would Like to Enroll In
ASL 102 - In-person (Sept 27 to Nov 1, 2023
6:30-8pm Central)
ASL 102 - Virtual (Nov 13 to Dec 18, 2023
6:30-8pm Central)
ASL 102 - Virtual Lunch (November 1 to December 13, 2023 12 - 1 pm Central (No class on Nov 22, 2023))
Please Select the
ASL 103 Class
You Would Like to Enroll In
ASL 103 - In-person (Sept 26 to Oct 31, 2023
6:30-8pm Central)
ASL 103 - In-person (Nov 15 to Dec 27, 2023
6:30-8pm Central
(no class 11/22))
Please Select the
ASL 104 Class
You Would Like to Enroll In
ASL 104 - Virtual (Sep 26-Oct 31, 2023 12-1pm Lunch Class)
ASL 104 - In-person (Nov 14 to Dec 19, 2023
6:30-8pm Central)
How much TOTAL for the Classes Signed Up for
Demographic Information
Why do we ask for this information? Our organizational funding depends upon the clients that we serve, and having this information helps us provide transparency and accountability to our funders. We appreciate your help!
Birthdate
Primary Language
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ASL
English
Spanish
Other (Please specify)
Gender
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Male
Female
Non-Binary
Prefer Not To Say
Race (please select all that apply)
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Asian
Hispanic/Latino
Native American
Native Hawaiian/Pacific Islander
Black/African American
White/Caucasian
Other
Marital Status
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Married
Widowed
Divorced
Separated
Never Married
Veteran Status
I am a veteran or active service member
I am not a veteran
Interested in other things happening at DAC?
Communication Preferences:
Subscribe to DAC Newsletter
Let me know about upcoming events
I am interested in volunteering at DAC
I am interested in upcoming classes
Payment Details
Registration Fee
Additional Donation to DAC (Optional)
Total Amount to Charge:
Payment Information
Name as it appears on card:
Card Number
MM
YY
Code
Email for Receipt
Contact Information