SAFE & SOBER GRAD NIGHT 2016
The Pacifica High School Class of 2016 Grad night will be held Wednesday, June 22, 2016, from 9:30 p.m. to 5:00a.m. the following morning. Seniors are to report to Grad Night check-in at the Pacifica High School gymnasium by 9:30 p.m. (Doors open at 9:00 p.m. if you want to avoid the crowd!) Buses will return to the senior parking lot at Pacifica High School at approximately 5:00 a.m. on Thursday, June 23. It is advisable that cars not be left in the parking lot overnight and that graduates arrange for transportation home in the morning. If a student has not checked in for Grad night departure by 10:30 p.m., their parents will be notified by phone. I understand that there will be a mandatory pat down and personal item check to help ensure the safety of all attendees and to protect the facility of any vandalism. No purses, backpacks, sleeping bags or pillows are allowed. I further understand that the following items are not allowed in the event facility for Grad Night 2016.
Alcohol/Flasks Matches
Any Illegal Substance Medications (OTC or prescription)
All Tobacco Products Pagers
Canes Sharp Objects
Chains/Wallet Chains Markers
Lighters Water Bottles
Weapons
I understand that graduates will ride the bus to and from the event. Graduates arriving by other transportation will NOT be admitted. I further understand that no student will be allowed to leave the facility at any time during the event______(initial)
I give permission for my son/daughter to be administered the following medicines on an as needed basis. We cannot administer any medications without this section being signed.
Tylenol/Ibuprofen ______
(Please circle one) Signature of Parent or Guardian
Graduate’s Pledge
I, ______, pledge that I will remain drug and alcohol free before, during and after our safe and sober grad night. I understand that a violation of this pledge will result in the forfeiture of my opportunity to participate in Grad Night and the fee paid to attend.
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Students Signature Date
Parents Acknowledgement
I/We, as parent/guardian of the above named graduate, understand that the possession and/or use of any alcohol and/or drugs before, during, or after the Safe and Sober Grad Night will result in his/her immediate dismissal from Grad Night and loss of fee paid to attend. I understand that I will be called and be required to pick up my son/daughter immediately.
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Parent/Guardian Signature Date
Please provide two names & phone numbers that a committee member can reach you at in case of emergency. PHONE NUMBERS WILL BE VERIFIED. NO SENIOR CELL PHONE NUMBERS WILL BE ACCEPTED.
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Parent/Guardian-please print clearly Phone number
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Parent/Guardian Name-please print clearly Phone number
PACIFICA GRAD NIGHT 2016 PERMISSION FORM
WHAT TO DO
FILL OUT PERMISSION SLIP AND RETURN WITH PAYMENT
IN ENVELOPE MARKED GRAD NIGHT
PAYMENTS CAN BE TAKENT TO ELVA (MRS. VILLALOBOS) IN THE SCHOOL OFFICE OR MAILED TO:
PHS GRAD NIGHT
C/O MELISSA PALMER
P.O. BOX 6404
GARDEN GROVE, CA 92845
GRADUATES NEED TO CHECK IN AT
PHS GYM @ 9:30 P.M. ON WEDNESDAY JUNE 22nd.
Doors open for check-in at 9:00
BRING NOTHING BUT THE FOLLOWING:
STUDENT I.D.,CAMERA (WITH NO CASE) AND CELL PHONE IF DESIRED.
DRESS CODE
NO PAJAMAS, APPROPRIATE ATTIRE FOR RESTAURANT
TRANSPORTATION
GRADUATES WILL RIDE THE BUS TO AND FROM THE EVENT
(Graduates will return at approximately 5:00 a.m. in the senior parking lot at Pacifica)
I authorize my son/daughter, ______to attend Grad Night 2016.
I understand and acknowledge that this activity, by its nature, poses the potential risk of serious injury to individuals who participate in it.
I understand and acknowledge that some of the injuries that may result from participating in this activity include, but are not limited to, the following: sprains/strains, fractured bones, cuts/abrasions, unconsciousness, head and/or back injuries and paralysis.
In the event of illness or injury, I hereby consent to whatever emergency medical or dental treatment and hospital care is necessary.
I understand, acknowledge and agree that I will hold Garden Grove Unified School District, its employees, officers, agents, the Grad Night Committee 2016, its officers and volunteers harmless from any and all liability or claims whatsoever, which may arise out of or in connection with participation in this activity. I understand that Garden Grove Unified School District and Pacifica High School are in no way affiliated with or are sponsoring this event. I understand and acknowledge that participation in this activity is completely voluntary.
I acknowledge that I have carefully read this Grad Night Voluntary Participation Form, that I understand and agree to it’s terms, and that the terms serve as a release and assumption of risk for my heirs, executor and administrators and for all members of my family.
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Signature of Parent/Guardian Date
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Signature of Parent/Guardian Date