Hidden Hills PTA Waiver 2023-2024

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

PARENT’S APPROVAL, STUDENT, FAMILY, AND PARTICIPANT WAIVER

Email *

Parent/Guardian's Name *

Student's FIRST NAME *

Student's LAST NAME *

Additional Family Members (include the names of all other students, siblings, and parents/guardians): *

Will participate in PTA-sponsored events for the school year 2023 to 2024, 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), 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, Yoga Club, Fitness Friday, and other Parent & Student(s) PTA-sponsored Events.

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 it is 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): *

I/we hereby advise that the above named minor(s) has 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. If yes, put first name of child and the allergy/condition): *

I/we, as parent(s) or guardian(s) of the minor(s), do hereby, for child/children, myself, my heirs, executors and administrators, release and forever discharge and hold harmless the California State PTA, the local PTA, and all PTA officers, 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): *

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): *

Mobile Phone Number: *

Including area code (XXX-XXX-XXXX)

Address / City / Zip Code: *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms