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?

Please re-enter Email

Street Address

City

State

Zip/Postal Code

I am

DeafHearingHard 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 101ASL 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

Gender

Race (please select all that apply)

Marital Status

Veteran Status

I am a veteran or active service memberI am not a veteran

Interested in other things happening at DAC?

Communication Preferences:

Subscribe to DAC NewsletterLet me know about upcoming eventsI am interested in volunteering at DACI 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

Code

Email for Receipt

Contact Information