Welcome to the Legacy Center (LCO) Virtual Summer Fun 2020.  Registration, Policies, Releases, and Acknowledgements.
Thank you for your interest in our Summer program via the L.C.O.  We ask that you complete this packet and review the policies, releases and acknowledgements below.

Camp runs for 4 weeks, beginning July 6, 2020 through July 30, 2020 and participants have the option of attending Monday/Wednesday OR Tuesday/Thursday from 11:30 am to 2:30 pm (6 hours). Cost is $180 per week.

Please contact info@theLCnet.com with any questions or concerns.
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Email *
FAMILY AND PARTICIPANT INFORMATION
Participant Name *
I would like to attend: *
Is participant attending: *
Gender *
If other, please expand
Age *
Current school or program, grade level, type of program *
Name of Parent/Guardian *
Best phone number to reach Parent/Guardian *
Address, City, State, Zip Code *
Is participant verbal? *
If "yes" or "partially" please share more and educate us about level of speech reliability. *
Does participant use alternative means to communicate? *
If "yes" or "sometimes" please indicate what type. *
Does participant have an iPad that can be used for specific program content (if suggested/necessary)? *
How proficient is participant with an iPad? *
Does participant have any sensory issues that we should be aware of? *
If "yes", or "sometimes", please explain and offer any strategies you think would be helpful for us to  assist in a sensory overload situation
Does participant have any dietary restrictions or allergies that we should be aware of? *
If "yes", please explain
Please share with us anything you think we should know to make participant's experience more enjoyable.
RELEASE OF LIABILITY
I, the undersigned, being aware of the health and physical condition of myself/my son/daughter, and having knowledge that my/their participation in any program may carry unknown risks to my/their health, am voluntarily participating in interactive activities delivered by Legacy Center instructors via a virtual platform.  

Having such knowledge, I hereby release the HUS Legacy Foundation, their representatives, agents, and successors from liability for accidental injury or illness that I/my son/daughter may incur as a result of participating in any activity, including but not limited to:  physical movement, fitness, literacy activities, cooking, music, tutoring, communication practice, typing instruction, art and crafting activities.

I hereby assume all risks connected therewith and consent to participation in said program(s).  I agree to disclose any physical limitations, disabilities, ailments or impairments, which may affect the ability of me/my son/daughter to participate in said program(s).

I have read this section.  I acknowledge consent as follows: *
Required
PERMISSION TO RECORD CAMP SESSIONS
I grant to the HUS Legacy Foundation the right to video record me, my child or other family members in connection with camp sessions.

I authorize the HUS Legacy Foundation, its assignees and transferees the right to copyright, use and/or publish the same in print and or electronically.  I agree that the HUS Legacy Foundation may use such photographs/videos of me with or without my name and for any lawful purpose, including for example, such purposes as marketing, social media campaign, advertising, and Web content.

I have read this section.  I acknowledge consent as follows: *
Required
HEALTH DECLARATION
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF MY CHILD IS IN GOOD PHYSICAL HEALTH AND IS CAPABLE OF PARTICIPATING IN CENTER ACTIVITIES, INCLUDING, BUT NOT LIMITED TO, ON-LINE ACTIVITIES SUCH AS  LITERACY, TYPING, ART, GARDENING, COOKING, WELLNESS AND PHYSICAL FITNESS. I HEREBY AUTHORIZE MY CHILD TO PARTICIPATE IN SUCH ACTIVITIES.
I have read this section.  I acknowledge consent as follows: *
Required
ACKNOWLEDGEMENT, CONSENT, AND RELEASE
I have read and been given the opportunity to ask any questions that I might have about the clauses outlined in this document.  I have indicated my consent by agreeing or disagreeing to all clauses.
Parent/Guardian agrees that a typed name below is the equivalent of an "in person" signature. *
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Please "e-sign" below (by typing your name) your acceptance and understanding of all terms contained herein. *
PAYMENT OPTIONS
You will be invoiced once your camp registration is confirmed.
I will be paying by: *
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