2022-2023 PTA Participation Waiver

To participate in PTA sponsored activities, this form must be completed and returned for every student each school year. You may register up to 4 students per form. To register more than 4 students, please fill out an additional form.

Number of Students

One Two Three Four

Do any of these students have allergies, medicine reactions or unusual physical condition which should be made known to a treating physician or which could limit participation?

Please choose a response

None Yes

Parent Name

Parent Phone

Parent Email (to receive a copy of your waiver)

Address

City

State

Zip Code

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