California State PTA: Parent's Approval, Student, Family, and Participation Waiver for 2022-2023

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This waiver will be completed annually for all students and their families at Kimberly Elementary School. Only one waiver per family is required. Please include all family members (students, parents/guardians, siblings who don't attend Kimberly, etc) who may participate in any Kimberly PTA-sponsored events for the 2022-2023 school year.

Email *

Minor's Name *

Participant's Date of Birth *

I/we hereby advise that the above named minor has the following allergies, medicine reactions or unusual physical conditions, which should be made known to a treating physician:

If none, please type the word "none".

If yes, please type the first name of child and the allergy/condition(s).

Add another minor (under 18) participant? *

Yes

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