If not registering online, please print this page. Senior AND guardian must both sign, regardless of student age.
Return this form by 3pm JUNE 5 with $75 cash to the West Potomac HS Main Office Attn: PTSA/ANGC
or bring this form with signatures AND $100 CASH ONLY to the event.
Return this form by 3pm JUNE 5 with $75 cash to the West Potomac HS Main Office Attn: PTSA/ANGC
or bring this form with signatures AND $100 CASH ONLY to the event.
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:
The student named plans to attend the West Potomac All Night Graduation Celebration (ANGC) on Thursday, June 6, 2019 at WPHS. We understand the following conditions apply to the celebration and agree:
1. Attendees MUST be 2019 graduates of West Potomac High School. NO GUESTS PERMITTED
2. All forms must be completed in entirety and payment received in order for students to attend the party.
3. Check-in begins at 9:30pm. Students MUST arrive no later than 10:30pm. Graduates arriving after 10:30PM will not be admitted. No exceptions. In this case, the guardian will be notified that the graduate arrived too late to attend the party. If a ticket is purchased and the student does not show at all, a call home will be made to confirm non‐arrival. This is designed as 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. Prize pickup is at the end of the event and will only be awarded to graduates who remain at the party. 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 bag, backpack etc. At check-in, grads will be provided with a bag to store items as well as to hold any prizes won. This bag remains in a secure room until check-out.
6. No outside food or drink permitted. No exceptions.
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 but are not limited to, physical fighting, yelling angrily, stealing, improper touching as defined by the SR&Rs, and any destruction of property. Graduates are expected to comply with directions of volunteers and staff in attendance. Parent/Guardian will be asked to pick up the graduate if he/she is asked to leave. Police/security will be in attendance.
8. This event runs from 9:30pm-4am. Students may leave early only after they have checked out with volunteers, security and a parent/guardian has been notified via phone. This is our due diligence.
9. A parent/legal guardian MUST be available by phone (numbers as listed on form) 10 pm June 6, 2019 thru 4 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 #:______________________(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 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
*Parent/Guardian must sign even if graduate is or will be 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:
The student named plans to attend the West Potomac All Night Graduation Celebration (ANGC) on Thursday, June 6, 2019 at WPHS. We understand the following conditions apply to the celebration and agree:
1. Attendees MUST be 2019 graduates of West Potomac High School. NO GUESTS PERMITTED
2. All forms must be completed in entirety and payment received in order for students to attend the party.
3. Check-in begins at 9:30pm. Students MUST arrive no later than 10:30pm. Graduates arriving after 10:30PM will not be admitted. No exceptions. In this case, the guardian will be notified that the graduate arrived too late to attend the party. If a ticket is purchased and the student does not show at all, a call home will be made to confirm non‐arrival. This is designed as 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. Prize pickup is at the end of the event and will only be awarded to graduates who remain at the party. 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 bag, backpack etc. At check-in, grads will be provided with a bag to store items as well as to hold any prizes won. This bag remains in a secure room until check-out.
6. No outside food or drink permitted. No exceptions.
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 but are not limited to, physical fighting, yelling angrily, stealing, improper touching as defined by the SR&Rs, and any destruction of property. Graduates are expected to comply with directions of volunteers and staff in attendance. Parent/Guardian will be asked to pick up the graduate if he/she is asked to leave. Police/security will be in attendance.
8. This event runs from 9:30pm-4am. Students may leave early only after they have checked out with volunteers, security and a parent/guardian has been notified via phone. This is our due diligence.
9. A parent/legal guardian MUST be available by phone (numbers as listed on form) 10 pm June 6, 2019 thru 4 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 #:______________________(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 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
*Parent/Guardian must sign even if graduate is or will be 18 years of age or older.