DVHS PTSA Waiver 2017-2018
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Family LAST NAME: *
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Name all family members: *
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will participate in PTA-sponsored events for the school year 2017 to 2018, which will include, but are not limited to the following:
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.
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 (our) knowledge and belief said parties are in good health and of sound mind. 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 attest and verify that I am physically fit and able to participate in this event and acknowledge that I am aware of the inherent risks in participating in any athletic event.
I hereby advise that the minor(s) identified below has had the following allergies, medicine reactions or unusual physical condition 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 / Participant Signature: (Type first and last name for signature) *
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Mobile Phone Number: *
Including area code (XXX-XXX-XXXX)
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Address / City / Zip Code: *
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A copy of your responses will be emailed to the address you provided.
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