Summer Workshop Series

Summer Workshop Series

Registration Form

Payment via Paypal
STUDENT INFORMATION
Full Name*

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PARENT INFORMATION
Parent #1 Full Name*

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E-mail*
Parent #2 Full Name*

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Cell Number*

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If parents are legally separated or divorced, who is authorized to make decisions on behalf of the minor?
Emergency Contact Information
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MEDICAL AND PROVIDER INFORMATION
Current medications:
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Is there anything we need to know for the SAFETY of your child or others while he or she is in our care?
PARENTAL/LEGAL GUARDIAN CONSENT AND RELEASE
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THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS

WAIVER / RELEASE / ASSUMPTION OF RISK
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SESSION INFORMATION
Social Foundation's Summer Workshops will be held at:
4530 Jasmine Ave in Culver City

Flexible Thinking, Self-Regulation, and Social Problem Solving Workshop

Dates and Times:

Ages: 5-7
Saturdays 9-10am

Ages: 8-10
Saturdays 10:15-11:15

Ages: 11-13
Saturdays 11:30-12:30

Session 1
July 6, 13, 20, 27

Session 2
August 3, 10, 17, 24

Session Rate:
$500
Friendship Connections, Social Conversations, and Joining Play Workshop

Date and Time:

Ages: 8-10
Mondays 4-5pm

Ages: 11-13
Tuesdays 4-5pm

Session 1
Mondays July 8, 15, 22, 29
Tuesdays July 9, 16, 23, 30

Session 2
Mondays August 5, 12, 19, 26
Tuesdays August 6, 13, 20, 27

Session Rate:
$500
POLICIES AND FEES

Please Initial Each Section
Payment:

Payment is due in full with this registration.

1. Payment can be made through this form via PayPal. (You must be connected to the Internet for PayPal submission.)

2. Payment can be made by credit card either by appointment at the Social Foundations office or by phone at 310-452-1311.

3. If choosing PayPal, please select the appropriate session(s), and then click the "Proceed to Checkout" button at the bottom of the page!
INITIALS
Refunds: Unfortunately, no refunds can be issued for any reason. In case of illness, we can allow a camper to attend a later session.
INITIALS
I understand and agree to the policies of Social Foundations LLC, as described above.
Parent Signature:typed name is an e-signature*
Date:*

MonthDayYear
Payment*
prevnext( X )
S.1- Flexible Thinking Workshop Co-ed - Ages: 5-7$500.00
Session 1 - Ages: 5-7 - Saturdays 9-10am - July 6, 13, 20, 27

S.1 - Flexible Thinking Workshop Co-ed - Ages; 8-10$500.00
Session 1 - Ages: 8-10 - Saturdays 10:15am-11:15am - July 6, 13, 20, 27

S.1 - Flexible Thinking Workshop Co-ed - Ages: 11-13$500.00
Session 1 - Ages: 11-13 - Saturdays 11:30am-12:30pm - July 6, 13, 20, 27

S.2 - Flexible Thinking Workshop Co-ed - Ages: 5-7$500.00
Session 2 - Ages: 5-7 - Saturdays 9-10am - August 3, 10, 17, 24

S.2 - Flexible Thinking Workshop Co-ed - Ages: 8-10$500.00
Session 2- Ages: 8-10 - Saturdays 10:15am-11:15am - August 3, 10, 17, 24

S.2 - Flexible Thinking Workshop Co-ed - Ages: 11-13$500.00
Session 2 - Ages: 11-13 - Saturdays 11:30am-12:30pm - August 3, 10, 17, 24

S.1 - Friendship Connections Workshop Co-ed Ages: 8-10$500.00
Session 1 - Ages: 8-10 - Mondays 4-5pm - July 8, 15, 22, 29

S.1 - Friendship Connections Workshop Co-ed Ages: 11-13$500.00
Session 1 - Ages: 11-13 - Tuesdays 4-5pm - July 8, 15, 22, 29

S.2 - Friendship Connections Workshop Co-ed Ages: 8-10$500.00
Session 2 - Ages: 8-10 - Mondays 4-5pm - August 5, 12, 19, 26

S.2 - Friendship Connections Workshop Co-ed Ages: 11-13$500.00
Session 2 - Ages: 11-13 - Tuesdays 4-5pm - August 5, 12, 19, 26

Total $0.00
PARENT/LEGAL GUARDIAN’S SIGNATURE:
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STUDENT INFORMATION

PARENT INFORMATION

Emergency Contact Information

MEDICAL AND PROVIDER INFORMATION

PARENTAL/LEGAL GUARDIAN CONSENT AND RELEASE

SESSION INFORMATION

POLICIES AND FEES