SF Police Youth Fishing Program: Enrollment
(print form and fill out)
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 _____________
City _____________________________ State _____________Zip _________
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