Tassajara Hills PTA 2018-19 PARENT’S APPROVAL, STUDENT, FAMILY, AND PARTICIPANT WAIVER
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Parent/Guardian Name *
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Student FIRST NAME: *
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Student LAST NAME: *
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Additional Family Members:
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Will participate in PTA-sponsored events for the school year 2018 to 2019, which will include, but are not limited to the following:
Elementary Schools:
Welcome Back Social, Bike Rodeos, Carnivals, Multicultural Events, Family Game, Math, or Science Night(s), STEM Club, Book Fair Events, Book Club, Family Dances, Odyssey of the Mind, Run Club, Walk-a-Thons, Jog-a-Thons, Enrichment Classes, Talent Show, Holiday Kids Shop, Street Smarts Events, Reflections, Sister School Activities, Festivals, Parent & Student(s) PTA-sponsored Events (i.e., Father-Daughter, Mother-Son, Mother-Daughter, Father-Son, or other parent-child events).

Middle Schools:
Welcome Back Social, Odyssey of the Mind, Multicultural Events, Dances, 8th Grade Promotion Party, Reflections, Sister School Activities.

High Schools:
Multicultural Event, Grad Night, Reflections, Sister School Activities.

The undersigned parent or guardian assumes all risks in connection with the family’s participation in any and all of the PTA sponsored activities.
The undersigned parent(s) or guardian(s) assume all risks in connection with the participation of all individuals listed above in any and all of the PTA sponsored activities.I attest and verify that all individuals listed above are 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 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.
Parent / Guardian / Participant Signature: (Type first and last name for signature) *
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I/we hereby advise that the above named minor(s) has the following allergies, medicine reactions or unusual physical conditions, which should be made known to a treating physician: (If none, please write the word “none”. If yes, put first name of child and the allergy/condition:) *
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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. Parent / Guardian / Participant Signature: (Type first and last name for signature) *
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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. Parent / Guardian / Participant Signature: (Type first and last name for signature) *
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A copy of your responses will be emailed to the address you provided.
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