2022-2023 School Year Ralston Sleep-In Permission Form
The following information is required by the Jefferson Country School District to participate in the Ralston Sleep-In fundraiser. 2 Parts. If you have more than one student, and all the info is the same for each, you can just put both kids names down so you don't have to fill the form out twice.

$50 Per Kid Full Night ($25 if Parent Volunteers overnight)
$25 Per Kid Half Night - Pickup at 10pm
$65/$35  Late Registration (Tuesday 5/2-Thursday 5/4)
$75/$45 Day of Registration

DROP OFF TIME: Friday, May 5th, 6:30pm (please eat dinner before arriving)
PICK-UP TIME: Saturday, May 6th, 8:30am (a light breakfast will be served)

MANY VOLUNTEERS AND DONATIONS NEEDED! Please sign up on Konstella or text Melissa Reiss 813-220-5174  
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This is a fundraiser. Have you kindly paid the registration fee on  Konstella or Via Check to the Front office? 

 *
What is your child(s) first name ? *
What is your 2nd child(s) first name ?
What is your 3rd child(s) first name ?
What is your child(s) last name ? *
What is your 2nd child(s) last name ?
What is your 3rd child(s) last name ?
What is your student's grade ? *
What is your 2nd student's grade ?
What is your 3rd student's grade ?
Parent/Guardians Name & Phone Number, where you can be reached during the event? *
Does your child have any health concerns, allergies to food or medicines? (If your child takes any medications, please bring the medication with your student and check it in with us that evening in the original packaging) *
I give my child permission to attend astronomy viewing in small groups on the field - weather permitting. *
I give my child(ren) Permission to attend the 2022 Ralston Sleep-In *
Dear Parents/Guardian: Please read carefully. Your electronic signature validates the following release.  Information and conditions of participation in the Ralston Sleep-In (May 5th-May 6th, 2023), which constitutes a formal parent/guardian release. I, being the parent of legal guardian of my child(ren) included above give my consent for emergency medical and surgical treatment in a licensed hospital by a licensed physician should his or her condition require it in my absence. I understand that in such a case, reasonable attempts would first be made to contact me, time and conditions permitting. As long as the medical or surgical treatment considered necessary in the situation is in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved, I impose no specific prohibitions regarding treatment unless stated below. By including your electronic signature below and providing today's date below you authorize this formal parent/guardian release. *
Liability Release: In consideration for my child/children participating in the 2023 Ralston Sleep-In event, I herby release Jefferson County Public Schools, it's personnel, and it's PTA representatives from any legal claim arising from the administration or medication and the administration of emergency medical treatment. Parent/Guardian electronic signature below and date validates this release. *
Verification of Medical Insurance: Please provide the following: Insurance Company Name, Policy Holder Name, Policy or Group Number, Insurance Company Phone Number *
Student Code of Conduct (Jefferson County Public School Board Policy) As a participant in the Ralston Sleep-In, which will take place from May 5th-May6th 2023, I acknowledge having read and agree to abide by the Jefferson County Pubic Schools' Code of Conduct document. The responsibilities of every student are: To help maintain an overall atmosphere conducive to learning and to respect the principle that no student shall engage in any activity which disrupts or shows clear and convincing evidence of threatening to interfere with public or private rights of others. To respect property, caring for it and protecting it from theft, at the same time respecting the individual property and staff and students in the same manner. To promote the physical safety and personal security of others, exercising in this pursuit a high degree of self-discipline. To personally refrain and discourage others from possessing or transmitting any kind of weapon. To refrain from using, possessing, buying or selling alcohol and narcotics or other dangerous drugs. To practice and encourage honesty in academics work and in all other transactions. To respect the staff by obeying all reasonable requests with equanimity and avoiding the use of profanity or obscene gestures. In addition, I will further strive to be friendly to all members of the group, accept the will of the majority whenever a matter of choice presents itself, and accept the suggestions and recommendations of the parent chaperones in all matters relating to the program or my personal conduct. I also agree that the activity sponsor reserves the right to terminate my participation for failure to maintain these standards of conduct.   Student(s) electronic signature below and date validates this agreement. *
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