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SF Police Youth Fishing Program: Enrollment

Youth Programs

 

fishing program logo

 

 

SF Police Youth Fishing Program

850 Bryant St, San Francisco, CA 94103
415-401-4664

Fishing Main | GreetingsQuestionnaire | Enrollment

 


(print form and fill out)

 

Youth Enrollment

 

Youngsters are invited to take part in the SAN FRANCISCO POLICE YOUTH FISHING PROGRAM. Fill out this application and mail to the below address. Names will be recorded in the order they are received, and youngsters will be notified as openings come up for future fishing trips. All applications must be signed by the applicant's parent or guardian.

 

Name ________________________________________Age _____________

 

Address _______________________________________________________

 

City _____________________________ State _____________Zip _________

 

Phone _________________________________________________________

 

Please Indicate interest: ____ Fresh Water _____ Salt Water

 

 


 

Parent / Guardian consent, release of liability, and authorization consenting to treatment of minor

 

I, the undersigned parent and / or legal guardian of

 

___________________________________________, do hereby grant permission for him/her to participate in activities of the San Francisco Police Youth Fishing Program and to ride in or be a passenger on any waterhome or other vessel or vehicle of whatever nature and to use equipment and facilities made available by the San Francisco Police Youth Fishing Program and, in consideration of the opportunity afforded to such minor, release the San Francisco Police Youth Fishing Program and other persons participating in any of its programs or activities from all causes of action, actions, damage, claims and demands, in law or in equity, of every kind and character, I may now or hereafter have against them.

 

In the event of injury, I , the undersigned parent or legal guardian, do hereby authorized the San Francisco Police Youth Fishing Program as agent for the undersigned to consent to any X-Ray examination, and 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 Medicine Practice Art. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of the aforesaid agent to give specific consent to any and all diagnosis, treatment or hospital care which the aforesaid mentioned physician in the exercised of his best judgment many deem advisable. This authorization is given pursuant to the provisions of Section 28.5 of the Civil Code Of California.

 

This authorization shall remain effective until revoked in writing.

 

 

____________________________________________________________________________________________________

Parent / Guardian Signature Date

 

Return To:
S.F. Police Youth Fishing Program
Attn: Officer Bob Ford
630 Valencia St
San Francisco, CA 94110

 

 

 

 

 


Last updated: 2/28/2013 12:35:28 PM