Secret Agent Society Social Skills Statement of Agreement:
Medical Release:
I hereby declare that I am the parent or legal guardian of the above-named child and that the information I have given is accurate.
I give my consent, in the event that all reasonable attempts to contact me or designated persons above have been unsuccessful, to West Coast Centre for learning personnel to seek medical treatment by the physician named above, or in the event the preferred practitioner is not available, by another licensed medical professional.
I hereby release and discharge West Coast Centre for Learning, it's agents, employees, and officers, from claims, demands, actions, or judgements which the undersigned ever had, now has or may have against West Coast Centre for Learning, it successors, or assigned, for all personal injuries or illness, which the child named above may suffer or incur as a result of the actions of West Coast Centre for Learning or in procuring medical treatment.
I certify that the child named above is in good health and free from communicable disease or illness.
Statement of Understanding:
I have read the program description, policies and information, and procedures of West Coast Centre for Learning and Secret Agent Society Small Group Program. I understand and agree with the philosophy and policies; I accept the conditions and terms stated therein.
