2024 WHS Post Prom Waiver Form
Winterset 2024 Post Prom Event
Saturday into Sunday, April 20-21, 2024
10:15 PM - 2:30 AM

Program Registration & Participation Waiver Form
*NOTE: Participant(s) and parent/legal guardian MUST complete this registration and waiver form in its entirety prior to participating in Post Prom events.  
All forms must be electronically returned by Thursday, April 18, 2024.

My student has my permission to participate in Winterset’s Post Prom.  He/she is either a Winterset Junior or Senior, or is the prom date of a Winterset student in one of these grades.  I understand that participants must check in to Post Prom between 10:15 and 11:00 PM on Saturday, April 20th or they will be unable to participate.  In addition, if any participant leaves before the hypnotist on Sunday, April 21st, his/her parents/legal guardians will be called.  Once a participant leaves Post Prom, there will be no re-entry allowed.  If any participant does not follow the rules or is disruptive, he/she will be asked to leave the event, and the parent/legal guardian will be called. Parent/legal guardian, please ensure a current phone number is noted on the form.

There will be a variety of entertainment, games, food, and prizes available to participants throughout the evening:  Hypnotist, Dodgeball, Karaoke, Game Truck, Yard Games, Inflatables, Mechanical Bull, Massage, Bubble Soccer, Prize Drawings, and Laser Tag. (Please understand that laser tag does include the potential of receiving an electrical current to your body through your hand.  It may also include running, jumping, falling and other miscellaneous physical activity.  If the participant has any medical condition(s) that would cause concern, do not let your son, daughter, etc. participate.)  

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Student LAST Name *
Student FIRST Name *
Student's Grade  *
If student does NOT attend Winterset High School, please list the name of the school they attend. 
Student Contact Number
 *
Parent/Guardian Name *
Parent/Guardian Phone Number (PLEASE make sure someone is available to answer this number during the Post Prom event) *
Alternative Phone Number *
Parent/Guardian Contact Email Address  *
Do you give permission for your child to participate in ALL activities listed above?  *
If you answered NO to the question above, please list what activities you to NOT give your child permission to participate in. 
WINTERSET POST PROM PARTICIPANT'S WAIVER, RELEASE, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

In consideration of permitting the above named participant(s) to participate in the above post prom events, the Undersigned hereby voluntarily releases, discharges, waives and relinquishes any and all actions or causes of action for personal injury, including death, or property damage occurring to him/herself arising as a result of participating in, or traveling to post prom, or any incidental activities. The Undersigned agrees that under no circumstance will he/she or his/her heirs, executors, administrators and assigns prosecute, present any claim for personal injury (including wrongful death) or property damage against Winterset Community Schools, any of its employees, or any post prom committee or for any of said or similar causes of action. The Undersigned acknowledges that he/she is complete aware of any potential danger incidental to engaging in any activity, fully and voluntarily assumes the risks of engaging in the activity.   The Undersigned has read this document and is fully aware of the legal consequences of signing it.  Winterset Post Prom reserves the right to photograph/video participants for potential future use. All photos/videos remain the property of Winterset Post Prom.  I, as the parent or guardian of the participant, acknowledge that I have read this Waiver, Release, Assumption of Risk and Indemnity Agreement and sign it on behalf of the participant with full knowledge and understanding of its contents.   

Parent electronic signature:
 *
I (student) request to participate in Post Prom and will follow all instructions provided by volunteers, instructors, or chaperones.  I understand that I will be asked to leave the event if asked to do so (due to not following rules or being disruptive.)  If my parent or guardian prohibits me from participating in an event, I will honor that wish by not participating.  

Student electronic signature below:
 *
Name of guest/date (they will need to fill out a separate form) Type N/A if no date *
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