Participation Waiver Header .png

Please complete one waiver per student who may participate in any Hewes PTA-sponsored events (such as dances, Highlander Days, etc.) for the 2018-2019 school year. This waiver needs to be completed by a parent or guardian ONLY.

Once completed, your form will be automatically submitted to our records when you click on the “Submit” button. After clicking on “Submit”, a message on your screen will say: “Thank you! Your student’s information has been submitted and recorded.” Please note: No email confirmation will be sent. If you have questions, contact hewespta@gmail.com.

This form only needs to be completed ONCE PER SCHOOL YEAR to cover all PTA-sponsored events. If you completed the waiver during registration or prior to the fall dance, you do not need to complete it again.

Birth Date *
Birth Date
Parent/ Guardian Approval for PTA-Sponsored Activities *
The undersigned parent or guardian assumes all risks in connection with the participation of the above named individual in any and all of the PTA sponsored activities. I attest and verify that the individual listed above is 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 the individual named above. I do hereby certify that to the best of my knowledge and belief all individuals named above are in good health. In the event that I, or other parent/guardian, cannot be reached in an emergency, I hereby give permission to secure proper treatment for my child(ren). I/we do hereby 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 medical or dental services. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs. I, as parent or guardian of the minor, 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.
I 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 write “NONE”.
By typing my first and last name below, I confirm that I have carefully read and fully understand this waiver and its contents. I am aware that this is a release of liability and I have signed it of my own free will.
Date *
Date
Address *
Address
Parent Phone Number *
Parent Phone Number
Student Participation Waiver Footer.png