8th Grade Grad Night Alternative Form

"*" indicates required fields

Please mark which option applies to you*

I will pay a reduced amount and/or I will pay in installments

I require a full scholarship

Amount to Contribute Today*

If Paying in Installments...*

So that we can budget, please let us know the total amount you plan to pay and your preferred payment schedule. We will follow up with you based on your response, but we do understand that plans change. Enter N/A if you are not payment in installments.

Student Name*

First Last

Student ID*

The undersigned parent(s) or guardian(s) assume all risks in connection with the participation of the student listed above in any and all of the PTA sponsored activities. I attest and verify that the student listed above is physically fit and able to participate in this PTA sponsored activity. Further I acknowledge that is it my responsibility to understand any inherent risks associated with this activity and communicate those risks to the student named above. I do hereby certify that to the best of my knowledge and belief the student named above is 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.

Allergies & Conditions*

I/we 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 the word “none”.)

I/we, as parent(s) or guardian(s) of the minor, do hereby, for my child, 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 this PTA sponsored activity. By signing below, I confirm that I have carefully read and fully understand its contents. I am aware that this is a release of liability and signed it of my own free will.

Please check*

By checking this box below, you are indicating your permission and agreement to the terms of this waiver.

I agree

Parent/Guardian Name(s)*

Email*

2nd Email

Phone*

2nd Phone

Parent/Guardian Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Payment Type*

Online payments are PREFERRED. A PayPal account is not required to make online payments. You may use a credit or debit card. If you must pay by check, please select this option below.

Pay online

Pay by check

Your ticket is not guaranteed until we receive your check made out to "SPMS PTA" with your student's name in the memo. We must receive your check by December 1, 2023.

Hand-deliver or mail to: SPMS PTA 1500 Fair Oaks Ave. South Pasadena, CA 91030

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