2021-22 PTA Permission Slip & Waiver
As SME begins the 2021-22 school year, PTA is planning fun community building events and fundraisers.  In order for your child to participate in any PTA sponsored activity, the PTA must obtain your permission to participate.  This one time form will serve as your permission slip for all PTA sponsored activities for the 2021-22 school year.  

The contact information requested in this form will only be used for official PTA business.  SME PTA will make our best efforts to guard the confidentiality of this information.  

Please complete a separate form for each student you have at SME.
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Student First Name *
Student Last Name *
Grade *
Teacher *
Parent/Guardian #1 Name (First & Last) *
Parent/Guardian #1 Email Address *
Parent/Guardian #1 Phone Number *
Parent/Guardian #1 Street Address
Parent/Guardian #1 City, State & Zip
Parent/Guardian #2 Name (First & Last)
Parent/Guardian #2 Email Address
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Street Address
Parent/Guardian #2 City, State & Zip
The undersigned parent(s)/guardian(s) assume(s) all risks in connection with the participation of all individuals listed above in any and all SME PTA sponsored activities.  I attest and verify that all individuals listed above are 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 that all individuals named above are in good health.  In the event that an event takes place in person and I, or the other parent/guardian, cannot be reached in an emergency, I hereby give permission to secure proper treatment for my child in accordance with PUSD policies and procedures, including that the undersigned will assume full responsibility for any such treatment, 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 SME 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 PTA sponsored activities.  By signing below, I confirm that I have carefully read and fully understand its contents and hereby give permission to the PTA to use my contact information below for official PTA purposes.  I am aware that this is a release of liability and signed it of my own freewill. *
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Signature (typed name is considered a signature) *
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