2023-2024 California State PTA: Parent's Approval, Student, Family, and Participation Waiver

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This form is REQUIRED to participate in Kimberly Elementary PTA-organized activities.

This waiver is completed annually.
One waiver is completed per family. Include all family members in your household (students, staff members, parents/guardians, siblings who don't attend Kimberly, etc) who may participate in any Kimberly PTA-sponsored event during the 2023-2024 school year.
Participants will be verified upon check-in at PTA events.

Once submitted, the waiver is good for all PTA programs, activities, and events for the entire 2023-2024 school year.

Email *

Family Name *

This name will be used to look up your family at Kimberly PTA events.

Adult Participants *

List the full name of each adult participant over the age of 18 on a separate line. For example:

1st Adult's Full Name
2nd Adult's Full Name

Adult Allergies/Medical Conditions *

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

If none, please select "None".

If yes, please select other and type the adult(s) name(s) and the allergy/condition(s).

None

Other:

Do you have any minors in your family? *

Select "Yes" if you have any minors under the age of 18 in your family.

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