Parent's Approval, Student Waiver, and Participants' Waiver
From The Maryland PTA:

Please print the name of all family members who may participate in any PTA sponsored events for the 2019/2020 school year (including student, siblings and parents)
Email address *
Participant Name / Age if minor child *
Your answer
Participant Name / Age if minor child
Your answer
Participant Name / Age if minor child
Your answer
Participant Name / Age if minor child
Your answer
Participant Name / Age if minor child
Your answer
Participant Name / Age if minor child
Your answer
Participant Name / Age if minor child
Your answer
Participant Name / Age if minor child
Your answer
Participant Name / Age if minor child
Your answer
Participant Name / Age if minor child
Your answer
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.
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.

I understand it is my responsibility to advise the PTA if the above named minor(s) have any allergies, medicine
reactions, or unusual physical conditions, which should be made known to a treating physician.

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 Maryland 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 Name Date *
Your answer
Parent/Guardian Name Date
Your answer
Address - City - State - Zip code - Phone *
Your answer
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