If not registering online, please print the form below, read, sign and turn-in with check payment. Return form and payment to WPHS Main Office ATTENTION: ANGC Registration. No paper tickets will be issued. Your canceled check is your receipt.
October 1 - November 30, 2018 - $50 December 1, 2018 - March 31, 2019 - $60
April 1 - May 30, 2019 - $75
October 1 - November 30, 2018 - $50 December 1, 2018 - March 31, 2019 - $60
April 1 - May 30, 2019 - $75
Parent Authorization and Acknowledgement of Risk
West Potomac High School 2019 All Night Graduation Celebration
By signing below, the graduate and their parent/guardian agree to the following:
I plan to attend the West Potomac All Night Graduation Celebration (ANGC) on Thursday, June 6, 2019 at West Potomac High School. I understand the following conditions apply to the celebration:
1. Attendees MUST be 2019 graduates of West Potomac High School. NO GUESTS PERMITTED
2. All forms must be completed in entirety in order for students to attend the party.
3. Time TBD anticipate Check in of attendees begins at 9:30PM. Students should arrive no later than 10:30PM to join the fun. Graduates arriving after 10:30PM will not be admitted. In this case, the parent will be notified that the graduate arrived too late to attend the party. If we have a ticket reservation and the student does not show at all, a call home will be made to confirm non‐arrival. While this is an all night celebration, students may leave but ONLY after they have checked out with security and a parent/guardian is notified. There is absolutely no re-entry. Parents/Guardians, please provide working phone numbers on the authorization forms.
4. Refunds‐‐Due to the nature of planning involved, there are no refunds and tickets are non-transferable.
5. What to bring to the party‐‐No need to bring a purse, bag, backpack etc. At check-in, grads will be given a paper bag to store items as well as to hold prizes that you may win during the party. This bag remains in the security room until you leave/check-out.
6. No outside food or drink permitted.
7. This is a drug, alcohol and smoke free event. Students are expected to behave appropriately and in a respectful manner, as stipulated by the Student Rights and Responsibilities (SR&Rs.) Any graduate who causes a disturbance during the event will be asked to leave. Disturbances include physical fighting, yelling angrily at another graduate or adult in attendance, stealing, improper touching as defined by the SR&Rs, and any destruction of property. The parent/guardian of the graduate will be asked to pick up the student and take him/her home. Police and security will be in attendance.
8. Students may leave ONLY after they have checked out with security and a parent/guardian has been notified via phone. Parents/guardians, please provide working phone numbers on the authorization form.
9. A parent/legal guardian MUST be available by phone (numbers listed on form) between 10 pm and 5 am June 7, 2019.
10. Students requiring medication and/or supplies must complete and return the EMERGENCY CARE AND MEDICAL AUTHORIZATION FORM below.
We, the undersigned, hereby release and agree to hold the West Potomac High School PTSA, the 2019 ANGC Committee and its volunteers, employees, and other officers, staff members, and agents blameless from any and all claims that may arise from my use and/or my child’s use or presence on and at such premises and activities. To the best of our knowledge, the graduate/my child is physically able to safely participate in this celebration and all of its activities. The graduate and their parent/guardian are responsible for the graduate’s actions.
_______________________________________ ___________________________________ _______________
Student Name (Printed) Student Signature Date
___________________________________ _______________________________________ _______________ Parent/Guardian Name (Printed) Parent/Guardian Signature* Date
Please circle payment form: Check #___________ or Online Payment
Home Address:______________________________________________________________________________________ Student Email: ______________________________________________________________________________________ Parent Email: _______________________________________________________________________________ Student Phone #: ____________________________Parent Phone #:___________________________________ Parent Interested in Volunteering? (check one) Y_______ N________
*Parents/Guardians must sign even if the graduate is 18 years of age or older.
****************************************************************************************************************************************************
EMERGENCY CARE INFORMATION AND MEDICAL AUTHORIZATION
WPHS 2019 ALL NIGHT GRADUATION CELEBRATION
In the case of an emergency, volunteers staffing the party will call 911. Every effort will be made to contact a parent, a guardian, or a designated emergency contact. All information below is MANDATORY.
STUDENT NAME:_______________________________________________________
IN CASE OF EMERGENCY DURING THE ANGC, CONTACT:
Printed Parent/Guardian Name(s):_____________________________________________________________________________
Home Phone Number:_____________________________________ Cell Phone Number:__________________
LIST TWO (2) PERSONS WE SHOULD CALL IN AN EMERGENCY IF THE PARENT(S)/GUARDIANS CANNOT BE REACHED: Contact Name:________________________________________ Phone Number:_____________________________
Contact Name:________________________________________ Phone Number:_____________________________ INSURANCE INFORMATION My child has medical coverage with _______________________________________________________________ (insurance carrier)
Please indicate all current health conditions that apply for your child. Write NA if there are none. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Allergies: Please list ALL allergies your child has. If your child is “allergy free” write NA. ________________________________________________________________________________________________________ Please list all medications and dosages that your child receives on a continual basis. Write NA if there are none. ________________________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________
Printed Parent/Guardian Name Parent/Guardian Signature* Date
*Parents must sign even if graduate is 18 years of age or older.
COMPLETE THIS SECTION OF THE FORM ONLY IF YOUR CHILD WILL BE CARRYING MEDICATION DURING THE PARTY Due to medical necessity, I do hereby give my permission for my child ________________________, to keep on his/her person at all times for the duration of the All Night Graduation Celebration and to self administer the following medication(s) and/or medical supplies/equipment that are listed below. Please be as specific as possible when listing. For medications, include dosages and times to be taken.
1. _____________________________________________________________________________________
2. _____________________________________________________________________________________
3. _____________________________________________________________________________________
4. _____________________________________________________________________________________
5. _____________________________________________________________________________________
I hereby release and agree to hold the West Potomac High School PTSA, the 2019 ANGC Committee and its volunteers, employees, and any of the officers, staff members, and agents blameless from any lawsuits, claims, expenses, demands or actions, etc. against them for permitting my child to carry and self administer the above mentioned medications and/or medical supplies/equipment for which I have given permission.
_________________________________________ ________________________________________________________
Printed Parent/Guardian Name Parent/Guardian Signature* Date
*Parents must sign even if graduate is 18 years of age or older.
West Potomac High School 2019 All Night Graduation Celebration
By signing below, the graduate and their parent/guardian agree to the following:
I plan to attend the West Potomac All Night Graduation Celebration (ANGC) on Thursday, June 6, 2019 at West Potomac High School. I understand the following conditions apply to the celebration:
1. Attendees MUST be 2019 graduates of West Potomac High School. NO GUESTS PERMITTED
2. All forms must be completed in entirety in order for students to attend the party.
3. Time TBD anticipate Check in of attendees begins at 9:30PM. Students should arrive no later than 10:30PM to join the fun. Graduates arriving after 10:30PM will not be admitted. In this case, the parent will be notified that the graduate arrived too late to attend the party. If we have a ticket reservation and the student does not show at all, a call home will be made to confirm non‐arrival. While this is an all night celebration, students may leave but ONLY after they have checked out with security and a parent/guardian is notified. There is absolutely no re-entry. Parents/Guardians, please provide working phone numbers on the authorization forms.
4. Refunds‐‐Due to the nature of planning involved, there are no refunds and tickets are non-transferable.
5. What to bring to the party‐‐No need to bring a purse, bag, backpack etc. At check-in, grads will be given a paper bag to store items as well as to hold prizes that you may win during the party. This bag remains in the security room until you leave/check-out.
6. No outside food or drink permitted.
7. This is a drug, alcohol and smoke free event. Students are expected to behave appropriately and in a respectful manner, as stipulated by the Student Rights and Responsibilities (SR&Rs.) Any graduate who causes a disturbance during the event will be asked to leave. Disturbances include physical fighting, yelling angrily at another graduate or adult in attendance, stealing, improper touching as defined by the SR&Rs, and any destruction of property. The parent/guardian of the graduate will be asked to pick up the student and take him/her home. Police and security will be in attendance.
8. Students may leave ONLY after they have checked out with security and a parent/guardian has been notified via phone. Parents/guardians, please provide working phone numbers on the authorization form.
9. A parent/legal guardian MUST be available by phone (numbers listed on form) between 10 pm and 5 am June 7, 2019.
10. Students requiring medication and/or supplies must complete and return the EMERGENCY CARE AND MEDICAL AUTHORIZATION FORM below.
We, the undersigned, hereby release and agree to hold the West Potomac High School PTSA, the 2019 ANGC Committee and its volunteers, employees, and other officers, staff members, and agents blameless from any and all claims that may arise from my use and/or my child’s use or presence on and at such premises and activities. To the best of our knowledge, the graduate/my child is physically able to safely participate in this celebration and all of its activities. The graduate and their parent/guardian are responsible for the graduate’s actions.
_______________________________________ ___________________________________ _______________
Student Name (Printed) Student Signature Date
___________________________________ _______________________________________ _______________ Parent/Guardian Name (Printed) Parent/Guardian Signature* Date
Please circle payment form: Check #___________ or Online Payment
Home Address:______________________________________________________________________________________ Student Email: ______________________________________________________________________________________ Parent Email: _______________________________________________________________________________ Student Phone #: ____________________________Parent Phone #:___________________________________ Parent Interested in Volunteering? (check one) Y_______ N________
*Parents/Guardians must sign even if the graduate is 18 years of age or older.
****************************************************************************************************************************************************
EMERGENCY CARE INFORMATION AND MEDICAL AUTHORIZATION
WPHS 2019 ALL NIGHT GRADUATION CELEBRATION
In the case of an emergency, volunteers staffing the party will call 911. Every effort will be made to contact a parent, a guardian, or a designated emergency contact. All information below is MANDATORY.
STUDENT NAME:_______________________________________________________
IN CASE OF EMERGENCY DURING THE ANGC, CONTACT:
Printed Parent/Guardian Name(s):_____________________________________________________________________________
Home Phone Number:_____________________________________ Cell Phone Number:__________________
LIST TWO (2) PERSONS WE SHOULD CALL IN AN EMERGENCY IF THE PARENT(S)/GUARDIANS CANNOT BE REACHED: Contact Name:________________________________________ Phone Number:_____________________________
Contact Name:________________________________________ Phone Number:_____________________________ INSURANCE INFORMATION My child has medical coverage with _______________________________________________________________ (insurance carrier)
Please indicate all current health conditions that apply for your child. Write NA if there are none. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Allergies: Please list ALL allergies your child has. If your child is “allergy free” write NA. ________________________________________________________________________________________________________ Please list all medications and dosages that your child receives on a continual basis. Write NA if there are none. ________________________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________
Printed Parent/Guardian Name Parent/Guardian Signature* Date
*Parents must sign even if graduate is 18 years of age or older.
COMPLETE THIS SECTION OF THE FORM ONLY IF YOUR CHILD WILL BE CARRYING MEDICATION DURING THE PARTY Due to medical necessity, I do hereby give my permission for my child ________________________, to keep on his/her person at all times for the duration of the All Night Graduation Celebration and to self administer the following medication(s) and/or medical supplies/equipment that are listed below. Please be as specific as possible when listing. For medications, include dosages and times to be taken.
1. _____________________________________________________________________________________
2. _____________________________________________________________________________________
3. _____________________________________________________________________________________
4. _____________________________________________________________________________________
5. _____________________________________________________________________________________
I hereby release and agree to hold the West Potomac High School PTSA, the 2019 ANGC Committee and its volunteers, employees, and any of the officers, staff members, and agents blameless from any lawsuits, claims, expenses, demands or actions, etc. against them for permitting my child to carry and self administer the above mentioned medications and/or medical supplies/equipment for which I have given permission.
_________________________________________ ________________________________________________________
Printed Parent/Guardian Name Parent/Guardian Signature* Date
*Parents must sign even if graduate is 18 years of age or older.