Patwin Elementary School 12th Annual PTA Walkathon “Feet to the Beat” Saturday, April 29, 2017 9 a.m. - 1 p.m. PARTICIPANT'S NAME______________________________________________________ TEACHER/GRADE______________

T-SHIRT SIZE ______________

Parents and Patwin Supporters: All monies, along with this sponsor sheet, will be due by April 14, 2017 (this means that the money should be collected at the time the donation is made). **Please return form with all money collected in the attached envelope to your teacher or to the office by April 14, 2017**. Late forms are not guaranteed a shirt at the event. Shirt: Participants must raise a minimum of $25 in order to earn a shirt. Register 3 students for $50 and each child will receive a shirt. (Students must be in the same family) **Please fill out a separate sponsor sheet for each parent or non-Patwin sibling who is walking and would like a shirt.**

Thank You for supporting Patwin Students! Money raised will help pay for the many programs and activities sponsored by the PTA. Sponsor’s Name and phone number

Amount Donated

1. 2. 3. 4. 5. (Attach an extra sheet, if needed)

Total $ Amount Collected:

____ My child cannot participate in this year’s event due to previous commitment, but we would like to sponsor another Patwin Student for this amount: ___$25 (get a shirt) ___ other ____ I will sponsor my child and another Patwin Student from the sponsor list and chosen at random for this amount: ___$25 (get a shirt) ___ other If you would like to add your child’s name to the list to be sponsored, please contact Sarah Rabin at [email protected]. Together, the Patwin Community will do what it can to get sponsorships and t-shirts to every child who wants to participate. • • •

Please make checks payable to Patwin PTA Please pay student at time donation is requested Donation is tax-deductible: taxpayer ID# 68-0277123

Permission Slip For child to participate, a Parent or Guardian must sign the permission slip on the other side!

Patwin Elementary School 12th Annual PTA Walkathon “Feet to the Beat” Saturday, April 29, 2017 9 a.m. - 1 p.m. California State PTA 2327 L Street Sacramento, CA 95816-5014

PARENT’S APPROVAL AND STUDENT WAIVER AND PARTICIPANTS WAIVER Name all Family Members:___________________________________________________________________________________

will participate in all PTA sponsored events for the school year 2016 to 2017. The undersigned parent or guardian assumes all risks in connection with the family’s participation in any and all of the PTA sponsored activities. I, the undersigned participant, intending to be legally bound, do hereby for myself and heirs, executors, administrators and assigns, forever waive release and discharge the California State PTA, all PTA officers, employees and agents from all liability, claims or demands for any damage, loss or injury to the student, the student’s property, or parent’s property or to myself in connection with participation in these activities, unless caused by the negligence of the PTA. I do hereby certify that to the best of my (our) knowledge and belief said parties are in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood and agreed that the undersigned will assume full responsibility for any such action, including payment of costs. I attest and verify that I am physically fit and able to participate in this event and acknowledge that I am aware of the inherent risks in participating in any athletic event. I (we) hereby advise that the above named minor has had the following allergies, medicine reactions or unusual physical condition which should be made known to a treating physician or which could limit participation: If none please write none. 1. _______________________________________ Parent/Guardian/Participant Signature

_____________________________________ Date

____________________________________________________ Print Name

(_____)___________________________________________ Telephone

______________________________________________________________________________ Address

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