Meadows PTSA Participant Waiver for 2023-2024 School Year
***ALL persons participating in PTSA events during the 2023-2024 school year (e.g. Fall Festival) must be listed on the form, including any infant siblings.

*Information collected on this form will not be shared outside of Meadows PTSA.

For more information on current and upcoming Meadows PTSA events, visit www.meadowsptsa.org
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Email *
Primary Parent/Guardian Name   *
Second Parent/Guardian Name
Second Parent/Guardian Email
Address, City, State and Zip Code *
Telephone number (xxx) xxx-xxxx *
Enter all MEADOWS students, along with grade and teacher name in the appropriate fields, as well as family members who might participate in PTA-sponsored events at some point in the 2023-24 school year:
Student 1 First & Last Name                                               *
Example: Johnny Smith
Student 1 Grade Level *
Student 1 Teacher Name     *
 Example: Mrs. Garcia
Student 2 First & Last Name                                              
Example: Johnny Smith
Student 2 Grade Level
Student 2 Teacher Name                
 Example: Mrs. Garcia
Student 3 First & Last Name                                            
Example: Johnny Smith
Student 3 Grade Level
Student 3 Teacher Name                
Example: Mrs. Garcia
Student 4 First & Last Name                                      
Example: Johnny Smith
Student 4 Grade Level
Student 4 Teacher Name                
Example: Mrs. Garcia
Family Members/Participants (separate with commas)                                                    
Please list any non-Meadows Elementary adults and children who may participate in PTA-sponsored events during the 2023-2024 year. For minor children, please include ages. Example: Jane Smith age 2, John Smith age 13, Jimmy Smith, Julie Jones
By clicking below, the above listed 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, said parties are in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood and agreed that the undersigned will assume full responsibility for any such action, including payment of costs.
I hereby advise that the above named minor has had the following allergies, medicine reactions, or unusual physical condition which should be made known to a treating physician or which could limit participation. If more than one minor is listed above, please specify to whom the following refers. (If none, please write none.) *
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.
By clicking 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. *
A copy of your responses will be emailed to the address you provided.
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