Notice: Need help with creating your account or purchasing a membership? Click here to view the PDF guide. Want to apply as a volunteer? Click here for instructions.
Step 1. Create Billing Contact
Step 2. Activate Account
Step 3. Account Activated
Contact Information
Note: Red text indicates required fields.
Billing First Name:
Billing Last Name:
Address 1:
Address 2:
Country:
Prov/State:
City:
Postal/Zip Code:
Phone 1:
Phone 2:
Email:
Client #:
Account Information
Username:
* We suggest your email address (Min Characters: 5)
Password:
Re-Type Password:
Password Strength
Note: For the best Password Strength rating include:
Uppercase and lowercase characters
Numbers
Symbols
Eight or more characters
Extra Information
Birthdate:
Gender Identity:
Gender Pronoun:
Guardian 1 Name:
Guardian 1 Phone:
Guardian 2 Name:
Guardian 2 Phone:
Emerg. Contact:
Emerg. #:
How did you hear about Ausome?:
How does your child best communicate? I.e. gestures, PECs system, fragmented speech, signs, full sentences etc. Please elaborate.:
Is your child fully toilet trained? If NO, please elaborate:
Is there anything else about your child that would be helpful for us to know? I.e. special interests, things to avoid or be aware of etc.:
What level of autism has your child been diagnosed with?:
This individual is a(n)...:
Medical Information
List any medication presently taken:
Do you have any of the following conditions or requirements?:
Allergies:
Yes
No
Epi-pen Required:
Yes
No
Other Medical Conditions:
Yes
No
Please explain:
I understand that, with the exception of the birthdate, the previous information only needs to be completed on the pages for child participants.
Univerus Rec