Summer Camp Camp 2021
Registration Form
We are trained in proper usage and administration of Epi-pens. In the unlikely event we suspect your child is having a severe anaphalactic reaction, is there any known medical reason why your child should NOT be administered epinephine?
a minor, do hereby authorize the directors of Social Foundations LLC for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general or special supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but it is given to provide authority and power on the part of aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician or surgeon in the exercise of his/her best judgment may deem advisable. This authorization shall remain effect until January 10, 2021 unless sooner revoked in writing and delivered to said agents.
Social Foundations Camp will be held at: 4530 Jasmine Ave Culver City CA 90232Camp hours:9am-2pmCamp rate:
$100/day
Sign up for one day or a whole week.
I understand and agree to the policies of Social Foundations LLC, as described above.
PARENTAL/LEGAL GUARDIAN CONSENT AND RELEASE
PLEASE READ CAREFULLY
THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS
WAIVER / RELEASE / ASSUMPTION OF RISK
Please click one of the PayPal options to complete payment and submit the form.