Parent, please provide your email below. A copy of your responses will be sent once your form has been submitted. We also suggest that you print a copy of your responses for your records before you click "Submit".
The undersigned parent(s) or guardian(s) assume all risks in connection with the participation of the individual listed above in any and all of the PTA sponsored activities.
I/We attest and verify that the individual listed above is physically fit and able to participate in any PTA sponsored activities. Further I acknowledge that is it my responsibility to understand any inherent risks associated with PTA sponsored activities and communicate those risks to all individuals named above.
I/We do hereby certify that to the best of my knowledge and belief all individuals named above are in good health. In the event that I, or other parent/guardian, cannot be reached in an emergency, I hereby give permission to secure proper treatment for my child(ren). I/We do hereby consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of the medical staff of the hospital or facility furnishing medical or dental services. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs.
I/We, as parent(s) or guardian(s) of the minor(s), do hereby, for my child/children, myself, my heirs, executors and administrators, release and forever discharge and hold harmless the California State PTA, the local PTA and all officers, directors, employees, agents and volunteers of the organizations, acting officially or otherwise, from any and all claims, demands, actions or causes of action which in any way arise from the participation of any individuals listed above in any PTA sponsored activities.
By signing below, I confirm that I have carefully read and fully understand its contents. I am aware that this is a release of liability and signed it of my own free will.
I/We further understand that any student possessing liquor or drugs, involved in a disruption or in any way presenting a danger to themselves or others, will be subject to removal from the premises and other appropriate action when necessary.
It is further understood that Senior Send-Off 2018 is not a Santa Clara Unified School District Function.