CALIFORNIA STATE PTA
2327 L Street, Sacramento, CA 95816-5014 (916) 440-1985 * Fax (916) 440-1986 * info@capta.org * www.capta.org
Parent's Approval, Student, Family, and Participant Waiver
The undersigned parent(s) or guardian(s) assume all risks in connection with the participation of all individuals listed below in any and all of the PTA sponsored activities.

I attest and verify that all individuals listed are physically fit and able to participate in any PTA sponsored activities. Further I acknowledge that it is my responsibility to understand any inherent risks associated with PTA sponsored activities and communicate those risks to all individuals listed below.

I do hereby certify that to the best of my knowledge and belief that all individuals named below 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 judgement 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 below in any PTA sponsored activities.

Please include the name of all family members who may participate in any PTA sponsored events for the 2018-19 school year (including student, siblings and parents):

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
I have read the "Parent's Approval, Student, Family, and Participant Waiver" above and accept the terms. *
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