Leland Senior Grad Night - June 8' 2022
Thank you for purchasing the Grad Night ticket. If you have not purchased the ticket yet, please make sure to purchase the ticket before filling out this form.

You can purchase via PayPal or submit a check in the front office. Checks must be made payable to Leland Parent Club with 'Grad Night' and 'Student Name' written on the memo line.

Your purchase via PayPal or written check is not complete until you complete this form. Please fill out all the participant information and read and accept the waivers below in order to be allowed entry at the event.

By filling out the form below, you are giving permission for your Senior to attend the Leland Grad Night 2022 on 6/8/22, taking place at Hornblower Cruises on the San Francisco Bay.  Further, you agree that if your student is unable to attend, refused attendance or sent home for inappropriate behavior, he/she will be sent home without a refund.

All students will travel by bus to and from The Berkeley Marina, CA. You understand that your student must be checked in at Leland and arrive and depart on the provided buses. Failure to arrive on the provided bus will result in your student not being able to enter the event. Students will not be released early or allowed to leave except on the provided bus.

Note: There is no vaccination requirements based on latest policy & guidelines.


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Student Name *
Student Email Address                                                                 *
Student Contact info *
Parent Name *
Parent Email Address *
Parent Phone # *
Emergency Contact / Phone # during event *
Liability Waiver for Leland Senior Grad Night 2022 *Leland Parent Club (LPC), a 501(c)(3), a US nonprofit and their respective volunteers, officers, directors, employees and agents (collectively, "Leland Parent Club & Leland High School"), seek a publicity release & authorization for use of pictures, videos, audios, names, titles, affiliations of participants in Leland Grad Night media, video, audio, pictures, movie for use some of this information on their website, communications and social media marketing to promote the cause of the non-profit. Publicity O.K.: Participants / Parent/ Guardians of Participants authorize "Leland Parent Club" and “Leland High School” to publicize the above event, program, audio, video, pictures and to use participants name, affiliation, relationship, photograph, video, audio, movie and above stated information for purposes of promotion, publication, commercial advertising, or any other purpose, now or at any time in the future. Participant/Parent/ Guardian of Participant understand and agree that Leland Parent Club or Leland High School may use any such Information: (1) in all manner and media whatsoever, whether now known or hereafter intended, including electronic and print media and the Internet; (2) without the payment of royalties or other compensation to anyone for this purpose; and (3) without the need to notify them or to seek further approval before doing so. Participants/ Parent/ Guardians of Participants and all involved acknowledge reading and understanding this Release and Authorization. The acceptance of one parent or guardian is on behalf of the spouse and on behalf of their minor participant. Participants/ Parent/ Guardians of Participants agree that this Release and Authorization fully and accurately expresses their understanding and has not been modified orally or in writing. *
Required
COVID-19 Waiver *On behalf of the Senior listed above, and as parent and lawful guardian of student listed above, I hereby give permission for the participant to participate in the Senior Grad Night event hosted by Leland Parent Club (LPC) at Hornblower Cruise. I am familiar with, and knowingly and voluntarily accept any and all risks associated with attending the event. I acknowledge that our participation in this program is wholly voluntary and is not part of any regular school curriculum. I specifically assume all risks and hazards associated with our participation in the event including, but not limited to, the risks associated with the COVID-19 or similar type virus. I understand that we will be associating with staff, volunteers, and other participants and may contract COVID-19, or other viruses and diseases, through our participation in the event. Although the participants and staff/volunteers are required to be fully vaccinated and may have their temperatures taken upon entering the facility, that precaution is not nearly adequate to prevent the spread of COVID-19 given, among other things, the relatively long incubation period, and the fact that many infected persons are asymptomatic. I understand and voluntarily assume the risk that we may acquire COVID-19, and that COVID-19 may subsequently be transmitted from us to other members of my household. I certify that we are in good health, have no fever, and have no current issues that make it unsafe for us to participate in the event, which may not have a medical professional at the venue. I will notify Leland Parent Club and will not attend the event if I develop a fever or illness or test positive for COVID-19. Further, I will notify Leland Parent Club of any test positive for COVID-19 14 days after the event in order to enable contact tracing by LPC. To the fullest extent permitted by law, I hereby agree to waive, release, and discharge any and all claims, causes of action, damages, and rights of any kind, including serious injury or death, against Leland Parent Club and San Jose Unified School School District, its insurers, the club and the district’s governing board, and all of their respective employees, agents, representatives, and volunteers (the “Released Parties”) arising from or relating in any way to our participation in the event. *
Required
If you paid via PayPal, please submit your paypal email used to purchase your tickets. Please ensure you have purchased your tickets using the paypal 'add to cart' button and enter your paypal email used to make that purchase so we can connect your form with your payment. *
If you paid via check, please confirm the check was dropped off at the Leland School office *
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