Participant Details
Please list all children and adults in your household who may attend PTA events this school year.
Children
Medical & Health Information
Allergies, Medications, or Conditions:
Please list any allergies, medicine reactions, or unusual physical conditions for any of the individuals named above that should be made known to a treating physician (e.g., "Jane - Peanut Allergy"). Leave blank if not applicable.
Terms, Assumption of Risk, & Liability Release
Please carefully read the following authorization and liability waiver:
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Assumption of Risk & Physical Fitness:
The undersigned parent(s) or guardian(s) assume all risks in connection with the participation of all individuals listed above in any and all PTA-sponsored activities. I attest and verify that all individuals listed above are physically fit and able to participate. 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.
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Medical Treatment & Emergency Authorization:
I/we certify that, to the best of my knowledge and belief, all individuals named above are in good health. In the event that I or another parent/guardian cannot be reached in an emergency, I hereby give permission to secure proper treatment for my child(ren). I/we 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 services. The undersigned assumes full responsibility for any such action, including payment of costs.
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Liability Release & Discharge:
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, 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 arising from participation in any PTA-sponsored activities.
Electronic Signature & Agreement
Electronic Signature Consent:
By typing your name below and submitting this form, you acknowledge and agree that your electronic signature is the legal equivalent of your manual/handwritten signature, consenting to all terms listed above.
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