DVMS PTSA 2021-2022 Participant Waiver (Google Form)
PTSA events include, but are not limited to: the Trek for Tech Walkathon, Math Counts, Reflections, and 8th Grade Celebration.  This waiver includes virtual and in-person events.
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Email *
Participants *
Print the name of ALL family members who may participate in any PTSA sponsored events for the 2021-2022 school year (including student, siblings and parents/guardians).
Participation, Medical and Hold Harmless Agreement
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/we 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/we 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 parents/guardians, 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/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.
Allergies *
I/we hereby advise that the above named minor(s) has the allergies listed below, 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.)
Agreement *
Required
Full Legal Name of Parent 1  as eSignature *
Full Legal Name of Parent 2 as eSignature
A copy of your responses will be emailed to the address you provided.
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