The 36th Annual
LOMA JOGATHON

Parent Permission & Pledge Form

PLEASE SUBMIT ONE PER CHILD
Confirmation / Receipt Emailed Upon Submission

Parent First Name

Parent Last Name

Child First Name

Child Last Name

Parent Email

Teacher

Photography - Do you give permission for your child to appear in Jogathon photos and videos?

Yes

No

Permission for Participation

I will communicate any health concerns about my child's participation to my child's teacher.

By checking this box, I hereby release all liability and agree to hold harmless the Loma Prieta Home and School Club & Loma Prieta Joint Union School District, its officials, agents and employees, from any claims arising out of my child, self and household's participation in this event. I have read, understand and accept full responsibility in participation.

--- Optional ---

Can you make a pledge to support our school?
If YES, fill out the boxes below

Enter a total FLAT donation

OR

Enter a PER LAP pledge

Making a payment now is the easiest option!

Enter either your total flat donation or estimate your payment by multiplying your per lap pledge by your child's estimated number of laps (see grade goals below).

Enter the amount you wish to pay today:

$

Alternatively, check the box below to receive an invoice after the Jogathon:

Please send me a Paypal Invoice for the above pledge amount after the Jogathon.

Thanks for registering for the 2023 Jogathon!

After filling out this form, please enter additional family and friend pledges on the next form. Our sincere thanks!
----->

What Does Your Pledge Support?

The Loma Prieta Home & School Club is the Parent / Teacher Organization for Loma Prieta Elementary school. The Jogathon has been our biggest fundraiser since 1988.

Your Jogathon Pledge supports our important enrichment programs at Loma Prieta - Please see "What We Do" section of our website for an overview of our programs.

Any Jogathon proceeds above what is needed for Loma HSC programs are used to support LPEF, the "Loma Prieta Educational Fund". LPEF funds classroom teachers, Art, Music, Counseling, PE, and technology at Loma Prieta Elementary School.

The 36th Annual LOMA JOGATHON

Parent Permission & Pledge Form

PLEASE SUBMIT ONE PER CHILD Confirmation / Receipt Emailed Upon Submission

Permission for Participation

--- Optional ---

Can you make a pledge to support our school? If YES, fill out the boxes below

OR

Making a payment now is the easiest option!

Enter either your total flat donation or estimate your payment by multiplying your per lap pledge by your child's estimated number of laps (see grade goals below).

Alternatively, check the box below to receive an invoice after the Jogathon:

After filling out this form, please enter additional family and friend pledges on the next form. Our sincere thanks! ----->

Family & Friend Additional Pledges

SUBMIT AS MANY AS YOU NEED! Tax Receipt Emailed Upon Submission

Select either a flat donation or a per lap pledge amount

Making a payment now is the easiest option!

Enter either your total flat donation or estimate your payment by multiplying your per lap pledge by this child's estimated number of laps (see grade goals below).

Alternatively, check the box to receive an invoice after the Jogathon:

Lap Goals

Kinder

9-9:30am

-GOLD GOAL -

9 laps

1st

9:30-10am

-GOLD GOAL -

10 laps

2nd

10-10:30am

-GOLD GOAL -

10 laps

3rd

10:30-11am

-GOLD GOAL -

11 laps

4th

11-11:30am

-GOLD GOAL -

11 laps

5th

11:30-Noon

-GOLD GOAL -

12 laps

The 36th Annual
LOMA JOGATHON

PLEASE SUBMIT ONE PER CHILD
Confirmation / Receipt Emailed Upon Submission

Can you make a pledge to support our school?
If YES, fill out the boxes below

After filling out this form, please enter additional family and friend pledges on the next form. Our sincere thanks!
----->

SUBMIT AS MANY AS YOU NEED!
Tax Receipt Emailed Upon Submission