If not registering online, please print this page, sign and turn in to school with check payment. Return this form and payment to the WPHS Main Office ATTN: PTSA/ANGC Registration.
Ticket Price - December 1, 2018 - April 21, 2019 - $60 April 22 - May 30, 2019 - $75
Ticket Price - December 1, 2018 - April 21, 2019 - $60 April 22 - 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 WPHS. I 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 in order for students to attend the party.
3. Check in of attendees begins at 9:30PM. Students need to 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 a ticket was purchased and the student does not show at all, a call home will be made to confirm non‐arrival. While 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. 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 given a paper bag to store items as well as to hold any prizes won. 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 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. The parent/guardian of the graduate will be asked to pick up the student if he/she is asked to leave. Police and security will be in attendance.
8. This event runs from 9:30pm-4am. Students may leave early only after they have checked out with security and a parent/guardian has been notified via phone. This is our due diligence for volunteer peace of mind. 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 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.
****************************************************************************************************************************************************
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 INFO: 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
*Parent/Guardian must sign even if graduate is or 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 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 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:
I plan to attend the West Potomac All Night Graduation Celebration (ANGC) on Thursday, June 6, 2019 at WPHS. I 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 in order for students to attend the party.
3. Check in of attendees begins at 9:30PM. Students need to 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 a ticket was purchased and the student does not show at all, a call home will be made to confirm non‐arrival. While 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. 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 given a paper bag to store items as well as to hold any prizes won. 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 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. The parent/guardian of the graduate will be asked to pick up the student if he/she is asked to leave. Police and security will be in attendance.
8. This event runs from 9:30pm-4am. Students may leave early only after they have checked out with security and a parent/guardian has been notified via phone. This is our due diligence for volunteer peace of mind. 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 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.
****************************************************************************************************************************************************
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 INFO: 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
*Parent/Guardian must sign even if graduate is or 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 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 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.