California State PTA
STUDENT, FAMILY, AND PARTICIPANT WAIVER
One form required per family.
Names of all Family Members (adults and children):
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have my permission to participate in all PTA sponsored events for the school year 2016 to 2017. The undersigned parent or guardian assumes all risks in connection with the family’s participation in any and all of the PTA sponsored activities.

I, the undersigned participant, intending to be legally bound, do hereby for myself and heirs, executors, administrators and assigns, forever waive, release and discharge the California State PTA, all PTA officers, employees and agents from all liability, claims or demands for any damage, loss or injury to the student, the student’s property, or parent’s property or to myself in connection with participation in these activities, unless caused by the negligence of the PTA.

I do hereby certify that to the best of my knowledge and belief, said parties are in good mental and physical health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood and agreed that the undersigned will assume full responsibility for any such action, including payment of costs.

I acknowledge that I am aware of the inherent risks in participating in any athletic event.

Allergies
I hereby advise that the above named minor(s) has or has had the following allergies, medicine reactions or unusual physical conditions which should be made known to a treating physician or which could limit participation (if none, please write "none"):
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Parent/Guardian Name (e-signature):
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Date:
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Address:
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Telephone:
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Email:
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