If not registering online, please print this page. Senior AND guardian must both sign, regardless of student age.
Return this form with $50 cash or check to the West Potomac HS Main Office Attn: PTSA/ANGC
Return this form with $50 cash or check to the West Potomac HS Main Office Attn: PTSA/ANGC
Parent Authorization and Acknowledgement of Risk
West Potomac High School 2020 All Night Graduation Celebration
By signing below, the graduate and their parent/guardian agree to the following:
The student named plans to attend the West Potomac All Night Graduation Celebration (ANG) on Thursday, June 4, 2020.
I understand the following conditions apply to this celebration:
_______________________________________ ___________________________________ _______________
Student Name (Printed) Student Signature Date
___________________________________ _______________________________________ _______________ Parent/Guardian Name (Printed) Parent/Guardian Signature* Date
Please indicate payment form: Cash________ Check #___________ Online Payment_______
Home Address:__________________________________________________________________________________________ Student Email: __________________________________________________________________________________________ Parent Email: ___________________________________________________________________________________________ Student Phone #: __________________Parent Phone #:______________________(1)_______________________________(2)
Parent Interested in Volunteering? (check one) Y_______ N_______
*Parent/Guardian must sign even if the graduate is/will be 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 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 listed below. Be as specific as possible when listing. For medications, include dosages and times to be taken.
1. _____________________________________________________________________________________
2. _____________________________________________________________________________________
3. _____________________________________________________________________________________
4. _____________________________________________________________________________________
I hereby release and agree to hold the West Potomac High School, PTSA, the 2020 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
*Parent/Guardian must sign even if graduate is or will be 18 years of age or older.
West Potomac High School 2020 All Night Graduation Celebration
By signing below, the graduate and their parent/guardian agree to the following:
The student named plans to attend the West Potomac All Night Graduation Celebration (ANG) on Thursday, June 4, 2020.
I understand the following conditions apply to this celebration:
- Attendees MUST be 2020 graduates of West Potomac High School. NO GUESTS PERMITTED.
- All requested forms must be complete in order for students to attend.
- Attendance. Check in of attendees begins at 9:30PM. Students should arrive no later than 10:30PM. Graduates arriving after 10:30PM will not be admitted, no exceptions. The parent/guardian will be notified of attendees arriving after check-in. Parent/guardians of registered students who do not check-in will be called to confirm non‐arrival. There will be a 12:30 AM release for students who do not want to stay until the end. Students may leave between 12:45AM and 4:30AM ONLY after checking out with security and chaperones have notified a parent/guardian. Parents/guardians, must provide working phone numbers on the authorization form.There is no re-entry.
- A parent/legal guardian MUST be available by phone (as provided on form) June 4, 2020 from 10:00PM to 3:30AM June 5.
- There are no refunds and tickets are non-transferable.
- Do not bring bags, purses, or backpacks. All attendees will be issued a paper bag at check-in to store personal items as well as any prizes. This bag will remain safely stored in the security room until check-out.
- No outside food or drink permitted. No exceptions.
- 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 attendee who causes a disturbance during the event will be asked to leave. Disturbances include but are not limited to, physical or verbal altercations, stealing, improper touching as defined by the SR&Rs, and/or any destruction of property. Attendees are expected to comply with directions of volunteers and staff in attendance. The student's parent/guardian will be called to pick up a student if s/he is asked to leave. Police and security will be in attendance.
- Students requiring medication and/or supplies must complete and return the MEDICAL AUTHORIZATION FORM located under the appropriate tab above.
_______________________________________ ___________________________________ _______________
Student Name (Printed) Student Signature Date
___________________________________ _______________________________________ _______________ Parent/Guardian Name (Printed) Parent/Guardian Signature* Date
Please indicate payment form: Cash________ Check #___________ Online Payment_______
Home Address:__________________________________________________________________________________________ Student Email: __________________________________________________________________________________________ Parent Email: ___________________________________________________________________________________________ Student Phone #: __________________Parent Phone #:______________________(1)_______________________________(2)
Parent Interested in Volunteering? (check one) Y_______ N_______
*Parent/Guardian must sign even if the graduate is/will be 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 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 listed below. Be as specific as possible when listing. For medications, include dosages and times to be taken.
1. _____________________________________________________________________________________
2. _____________________________________________________________________________________
3. _____________________________________________________________________________________
4. _____________________________________________________________________________________
I hereby release and agree to hold the West Potomac High School, PTSA, the 2020 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
*Parent/Guardian must sign even if graduate is or will be 18 years of age or older.